Airway management for cervical spine surgery

Abstract

Airway managementfor cervical spine surgery represents a crucial step in the anesthetic management to avoid injury to spinal cord. Proper airway management is to maintain the neck in neutral position with manual in-line stabilization during intubation, especially in cases of instability and myelopathy. External stabilization methods may reduce movement during direct laryngoscopy, but they will make glottic visualization more difficult. Video laryngoscope for intubation has been welcome as an efficient tool for difficult airway. The video laryngoscope produces better glottic visualization compare to direct laryngoscope during intubation with manual in-line stabilization. However, it does not significantly decrease movement of cervical spine when compare to direct laryngoscope. Fiberoptic intubation is the method of choice to reduce motion in the cervical spine. The most serious complication associated with anterior cervical spine surgery is the airway obstruction due to hematoma. Guidelines for prevention and management will be preceded by a review of etiologic factors and diagnostic considerations.