The safety of awake tracheal intubation in cervical spine injury.
As a referral centre for cervical spine injuries, we have routinely performed awake tracheal intubation when intubation was indicated. A retrospective case control study was undertaken to review the frequency of neurological deterioration and aspiration associated with our approach. Neurological deterioration was assessed by a change in level of injury or neurological grade at admission and discharge. Four hundred and fifty-four patients with critical cervical spine and/or cord injuries were reviewed over an eight-year period. A case group of 165 patients underwent tracheal intubation awake within two months of injury. A control group of 289 remained unintubated during the same period. A comparison of spinal neurological status between admission and discharge revealed no statistically significant difference in neurological deterioration between the two groups. This occurred despite a greater injury severity score in the case group. No evidence of aspiration during intubation was documented. We conclude that awake tracheal intubation is a safe method of airway management in patients with cervical spine injuries.
Meschino
A
A
Department of Anaesthesia, Sunnybrook Health Science Centre, University of Toronto, Ontario.
Devitt
J H
JH
Koch
J P
JP
Szalai
J P
JP
Schwartz
M L
ML
D000328:Adult; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000293:injuries*; D003243:Consciousness; D006801:Humans; D007103:Immobilization; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D009460:Neurologic Examination; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*; D016103:Spinal Fractures / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014143:Traction