title: Caring for the patients with cervical spine injuries: what have we learned?
abstract: OBJECTIVE
  Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors related to initial management, diagnosis, airway and anesthetic management of patients with CSI are presented.
  
  
  METHODS
  Medline search was performed to seek out the English-language literature using the following phrases and keywords: spine trauma; cervical spine; airway management after CSI.
  
  
  RESULTS
  Cervical spine injury occurs in up to 3% to 6% of all patients with trauma. The initial management of a patient with potential spine injury requires a high degree of suspicion for CSI so that early stabilization of the spine can be used to prevent further neurological damage. Diagnostic radiology has a critical role to play; however, clinical evaluation is equally important in excluding CSI in a conscious and cooperative patient. Although in-line stabilization reduces the movement at C-spine, traction causes clinically significant distraction and should be avoided.
  
  
  CONCLUSIONS
  A high level of suspicion and anticipation are the major components of decision making and management in a patient with CSI. Endotracheal intubation using the Bullard laryngoscope may have some advantages over other techniques as it causes less head and C-spine extension than the conventional laryngoscope, and this results in a better view. However, the current opinion is that oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI. In summation caution, close care and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique.
authors.affiliation: Department of Anesthesiology, Arkansas Children's Hospital, Little Rock, AR 72202, USA. ghafoorabidul@uams.edu
authors.forename: Abid U
authors.initials: AU
authors.lastname: Ghafoor
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Martin
authors.forename: Senthil
authors.initials: S
authors.lastname: Gopalakrishnan
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Viswamitra
mesh_terms: D000758:Anesthesia / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007103:Immobilization / Q000379:methods; D007297:Inpatients; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods; D011859:Radiography; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000628:therapy*