airway management for patients with cervical spine disorders l.
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Airway management for patients with cervical spine disorders - PowerPoint PPT Presentation


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Airway management for patients with cervical spine disorders. Presented by R3 吳佳展 . Case presentation. 30 year-old man Hyperextension injury C4-5 HIVD Muscle power: lower extremities 1, upper 3 HR, BP, vital capacity within normal range Intubated with light wand under general anesthesia

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case presentation
Case presentation
  • 30 year-old man
  • Hyperextension injury
  • C4-5 HIVD
  • Muscle power: lower extremities 1, upper 3
  • HR, BP, vital capacity within normal range
  • Intubated with light wand under general anesthesia
  • No neurological deterioration after surgery
trauma patients
Trauma patients
  • Pathology of cervical spine
  • Stability
  • Preoperative neurological deficits
  • Airway patency
  • Respiratory function
  • Cardiovascular compromise
  • Full stomach
trauma patients4
Trauma patients
  • Other associated injuries
  • Facial injury: interfere with mask ventilation
  • 1~2% of trauma patients have cervical spine injury
  • 10% of high-risk patients (head-first fall, high speed motor vehicle accidents)
  • Stabilization makes intubation more difficult
evaluation
evaluation
  • Neck pain or tenderness: only valid in alert patients without other painful lesions
  • Neurological examination
  • Plain films: lateral, AP, open mouth. Sensitivity~90%
  • CT scan
  • MRI
airway management
Airway management
  • No guidelines in this area
  • Awake or under general anesthesia
  • Nasal or oral
  • Blind, larygoscope, fiberoptic bronchoscope, Bullard scope, Combitube, light wand, LMA, Fastrach, gum elastic bougie, Wu’s scope
  • Surgical airway: tracheostomy, cricothyroitomy
factors determining methods used
Factors determining methods used
  • Urgency: most rapid and secure method is preferred
  • Experience of anesthesiologist
  • Patients’ cooperation
  • Airway anatomy
  • Mechanism of injury: flexion, extension
standard
“standard”
  • Oral laryngoscope with manual in-line stablization
  • Blind nasal intubation in awake patients
  • Nasal fiberoptic intubation
comparison between methods
Comparison between methods
  • Outcome
  • Radiological study: normal patients, with cervical spine pathology but without instability, cadaver
  • Upper or lower cervical spine injury
outcome study
Outcome study
  • No difference between awake or GA, nasal or oral intubation (retrospective)
  • few studies comparing other airway management methods based on outcome, possibly because they are not widely used
effect of airway maneuver
Effect of airway maneuver
  • Cadaver study
  • Unstable C5-C6: chin lift=jaw thrust=oral intubation>nasal intubation in spine movement
  • Unstable C1-C2: space available for spinal cord oral=nasal>chin lift and jaw thrust
bullard vs macintosh
Bullard vs. Macintosh
  • Patients requiring GA with normal cervical spine
  • Measured with c-arm
  • Extension: BUL with ILS (in-line stabilization)< BUL=MAC with ILS<MAC
  • Intubation time: in reversed order
no neck motion
No neck motion?
  • Blind nasal
  • Nasal fiberoptic intubation: may cause the least movement compared other conventional methods
  • Trachlight
  • Fastrach
  • Combitube
fastrach
Fastrach
  • Patients with cervical pathology (metastasis, disc prolapse, OPLL)
  • With light wand guide
  • Flexion and posterior displacement C0~C5
fastrach15
Fastrach
  • Cadaver
  • Pressure sensor placed at C2-3
  • Control: nasal/oral, laryngoscope/ fiberscope
  • Fastrach produces greater pressure against cervical spine and greater posterior displacement
fastrach vs laryngoscope
Fastrach vs. laryngoscope
  • Flexion vs. extension
  • Fastrach used in extension injury?
  • Laryngoscope used in flexion injury?
trachlight vs fastrach

Trachlight vs. Fastrach

Patients with cervical spine pathology

Higher success rate at first attempt

Less time required

No data about cervical spine movement was provided