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Airway Management in Cervical Spine Pathologies

  • Airway Management (LC Berkow, Section Editor)
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Abstract

Purpose of Review

Traumatic and non-traumatic pathologic processes can make airway management difficult. An understanding of pathologic mechanisms is important in identifying patients at risk. We aim to present a classification of cervical spine pathologies that can affect airway management.

Recent Findings

Stability of the cervical spine relates to its ability to limit the pattern of displacement under physiologic loads. Traumatic injuries are common but not the only causes of instability. Not all cervical spine pathologies are unstable. Secondary injuries can occur following movement, hypotension, or hypoxemia. Recently, there have been changes in guidelines of cervical spine movement and clearing of the cervical spine. History, physical exam, radiologic study, and communication with the surgeon are keys to planning a successful airway management strategy. Unnecessary immobilization can have deleterious effects. Displacement can happen during mask ventilation and placement of supraglottic airways. Flexible bronchoscopy, videolaryngoscopy, and manual inline stabilization can decrease cervical spine movement. Vigilance during and after extubation is crucial to diagnose airway impairment.

Summary

A careful attention to pathophysiology of cervical spine injuries and deformities, review of imaging, and availability of trained and expert individuals are important in the management of these patients.

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Authors and Affiliations

  1. Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Ave. E-31, Cleveland, OH, 44195, USA

    Mariel Manlapaz, Jean Beresian & Rafi Avitsian

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  1. Mariel Manlapaz
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  2. Jean Beresian
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Correspondence to Rafi Avitsian.

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Conflict of Interest

Mariel Manlapaz and Jean Beresian have declared they have no conflict of Interest. Rafi Avitsian has declared honorariums; support for attending meetings, leadership, and committee membership roles in SNACC and ASA; receipt of equipment for study related to airway management; and multiple patents related to airway management devices.

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Search Strategy

A literature search was conducted focusing on newer references and differences with historical recommendations. Keywords were included in literature search all-inclusive in anesthesiology, emergency medicine, neurosurgery, trauma, and imaging specialties.

This article is part of the Topical Collection on Airway Management

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Manlapaz, M., Beresian, J. & Avitsian, R. Airway Management in Cervical Spine Pathologies. Curr Anesthesiol Rep 12, 373–381 (2022). https://doi.org/10.1007/s40140-022-00523-3

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