title: Management of the airway in patients undergoing cervical spine surgery.
abstract: The perioperative management of the airway in patients with cervical spine disease requires careful consideration. In an observational prospective cohort study, we assessed the preoperative factors that may have influenced the anesthesiologists' choice for the technique of intubation and the incidence of postoperative airway complications. We recorded information from 327 patients: mean (+/-SD) age 51+/-15 year, 138 females and 189 males, for anterior surgical approach (n=195) and posterior (n=132). The technique of intubation used was awake fiberoptic bronchoscopy (FOB) in 39% (n=128), asleep FOB 32% (n=103), asleep laryngoscopy 22% (n=72), and other asleep 7% (n=24). Awake FOB was predominately chosen for intubating patients with myelopathy (45%), unstable/fractured spine (73%), and spinal stenosis (55%) but patients with radiculopathy had more asleep FOB (49%) (P<0.001). There was no association between method of intubation and postoperative airway complications. Acute postoperative airway obstruction occurred in 4 (1.2%) patients requiring reintubation. The technique of management of the airway for cervical spine surgery varied considerably among the anesthesiologists, although the choice was not associated with postoperative airway complications.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Pirjo.Manninen@uhn.on.ca
authors.forename: Pirjo H
authors.initials: PH
authors.lastname: Manninen
authors.forename: Geraldine B
authors.initials: GB
authors.lastname: Jose
authors.forename: Karolinah
authors.initials: K
authors.lastname: Lukitto
authors.forename: Lashmi
authors.initials: L
authors.lastname: Venkatraghavan
authors.forename: Hossam
authors.initials: H
authors.lastname: El Beheiry
mesh_terms: D000402:Airway Obstruction / Q000150:complications; D001999:Bronchoscopy / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data*; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications / Q000601:surgery; D012307:Risk Factors; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery; D014851:Wakefulness