Airway management in the patient with potential cervical spine instability: continuing professional development.
OBJECTIVE
Securing the airway of a patient with a potentially unstable cervical spine (C-spine) is a complex and challenging task. The objective of this continuing professional development module is to review the current knowledge essential for airway management in the face of potential C-spine instability and, at the same time, to underline areas of uncertainty and limitations in the literature.


RESULTS
In low-risk patients-defined by strict criteria derived from large multicentre studies-the C-spine can be considered stable or "cleared" without imaging. In all other patients, at least a thin-section computed tomographic examination of the spine from the occiput to T1 should be obtained, including sagittal and coronal multiplanar reconstructed images. Until the C-spine is cleared, it should be immobilized in the neutral position using a rigid cervical collar, sandbags, tape, and a backboard. During airway management, the anterior part of the cervical collar should be removed, and manual in-line stabilization should be applied. Some airway techniques, such as fibreoptic bronchoscopy and the Trachlight(®), have been shown to induce less C-spine movement than direct laryngoscopy; however, the impact of such airway management on outcome is uncertain.


CONCLUSIONS
Adequate airway management in the patient with potential C-spine injury demands an understanding of C-spine anatomy, the criteria required to clear the C-spine, and the indications, techniques, and pitfalls of C-spine immobilization. When choosing an airway technique, minimization of C-spine motion should be considered, but the method of choice should also incorporate the broader clinical context.
Département d'Anesthésiologie, Centre Hospitalier de l'Université de Montréal, Pavillon Notre-Dame, 1560 Sherbrooke Est, Montreal, QC H2L 4M1, Canada. arnaud.robitaille@umontreal.ca
Arnaud
A
Robitaille
D058109:Airway Management / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods; D002574:Cervical Vertebrae; D005336:Fiber Optic Technology; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007828:Laryngoscopy / Q000379:methods; D012306:Risk; D013124:Spinal Injuries / Q000503:physiopathology*; D013131:Spine / Q000033:anatomy & histology / Q000503:physiopathology