Combined Use of Video Laryngoscopy and Fiberoptic for Airway Management in a Patient With Fixed Cervical Spine

The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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“…Case reports also observed successful intubation occurring with various combinations of techniques (Category B4-B evidence). 447–468…”

Section: Anticipated Difficult Airway Managementmentioning

confidence: 99%

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

675

547

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“…A study by Lenhardt et al 42 reported that this technique has a higher success rate of intubation in the difficult airway, especially during intubations with in-line stabilization. Moda et al 43 also published a case report of successfully intubating a patient with a difficult airway of the fixed C-spine with distorted anatomy. This is a relatively new technique, and research is still going on to determine the advantage of this technique over other techniques.…”

Section: Videolaryngoscope-assisted Fiberoptic Bronchoscopymentioning

confidence: 99%

Airway management pearls in cervical spine disorders

Jangra

Rath

2023

International Anesthesiology Clinics

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Cervical spine (C-spine) pathologies that can cause compression on the spinal cord include acute trauma, congenital, and inflammatory disorders. The most important goal in managing a patient with C-spine pathology is to prevent further insult or aggravation of spinal cord injury. Even though the evidence is weak, manipulations of the head and neck during airway management of patients with C-spine pathology have been implicated in neurological deterioration. [1][2][3][4][5][6][7][8][9] The "sniffing position," used during intubation with direct laryngoscopy (DL), aligns the oral, oropharyngeal, and laryngeal axis. To attain this position, the lower C-spine is flexed, and extension occurs at the occipitalatlantoaxial (OAA) complex. In unstable C-spine pathology, such manipulations may result in displacement or subluxation of the bony elements, which may aggravate spinal cord compression and injuries.Neurological deterioration may occur due to the natural course of C-spine disease, surgical manipulation, and hemodynamic derangements. When managing the airway, the anesthesiologist's role is mostly to limit C-spine movements during intubation. The recent literature shows that using modern intubation equipment and techniques makes it easy and safe to intubate patients with C-spine pathology.Knowledge of the relevant anatomy, biomechanics, various pathologies affecting the C-spine, and the assessment of C-spine stability is important for anesthesia providers. This review covers, in brief, all these relevant aspects and focuses on current literature on various intubation techniques. Clinical anatomy of the C-spineBoth bony and ligamentous structures contribute to the stability of the spine. Perioperative physicians should know about these elements to identify the unstable C-spine. The foramina transversaria, through which the vertebral arteries pass, is a core structure of the cervical vertebra. Of 7 cervical vertebrae, the first, second, and seventh vertebrae are atypical, while the third to sixth are typical vertebrae. The upper 2 cervical vertebrae are anatomically and functionally different from the lower 5. These structures will be discussed separately.

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Use of video laryngoscope as a conduit for the passage of endoscope: Expanding the horizon

Saini

Barik

Agrawal

et al. 2023

Indian J Gastroenterol

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Combined Use of Video Laryngoscopy and Fiberoptic for Airway Management in a Patient With Fixed Cervical Spine

Cited by 3 publications

References 5 publications

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *

Airway management pearls in cervical spine disorders

Use of video laryngoscope as a conduit for the passage of endoscope: Expanding the horizon

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