Airway management in the adult patient with an unstable cervical spine

Abstract

Purpose of reviewThe ideal airway management of patients with unstable spinal injury presents a perennial challenge for anaesthesiologists. With competing interests, potentially catastrophic complications, and a scarcity of evidence to support common practices, it is an area rich with dogma and devoid of data. This review seeks to highlight recent evidence that improves our assurance that what we do to manage the airway in the unstable cervical spine is supported by data. Recent findingsThe increasing range of available technology for intubation provides important opportunities to investigate the superiority (or otherwise) of various techniques -and a chance to challenge accepted practice. Longheld assumptions regarding spinal immobilisation in the context of airway management may require refinement as a true base of evidence develops. SummaryVideo laryngoscopy may replace direct laryngoscopy as the default technique for endotracheal intubation in patients with suspected or confirmed spinal instability. Immobilisation of the unstable cervical spine, manually or with rigid cervical collars, is increasingly controversial. It may be that hard collars are used in specific circumstances, rather than as universal precaution in the future. There are no recent data of significantly high quality to warrant wholesale changes to recommended airway management practice and in the absence of new information, limiting movement (in the suspected or confirmed unstable cervical spine) remains the mainstay of clinical practice advice.

Editorial: Neuroanaesthesiology editorial

“…Fibreoptic technology has been usefully applied in the development of videolaryngoscopy systems. D' Arville et al [10] discuss the role of these systems in the airway management of patients with unstable cervical spine fractures. It is likely that videolaryngoscopy may soon replace more traditional approaches to airway management such as direct laryngoscopy with manual in-line stabilization or awake fibreoptic intubation.…”