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Management of the Airway in Patients Undergoing Cervical Spine Surgery

Manninen, Pirjo H. MD, FRCPC; Jose, Geraldine B. MD; Lukitto, Karolinah MD; Venkatraghavan, Lashmi MD; El Beheiry, Hossam MBBCh, PhD, FRCPC

Journal of Neurosurgical Anesthesiology: July 2007 - Volume 19 - Issue 3 - p 190-194
doi: 10.1097/ANA.0b013e318060d270
Clinical Reports

The perioperative management of the airway in patients with cervical spine disease requires careful consideration. In an observational prospective cohort study, we assessed the preoperative factors that may have influenced the anesthesiologists' choice for the technique of intubation and the incidence of postoperative airway complications. We recorded information from 327 patients: mean (±SD) age 51±15 year, 138 females and 189 males, for anterior surgical approach (n=195) and posterior (n=132). The technique of intubation used was awake fiberoptic bronchoscopy (FOB) in 39% (n=128), asleep FOB 32% (n=103), asleep laryngoscopy 22% (n=72), and other asleep 7% (n=24). Awake FOB was predominately chosen for intubating patients with myelopathy (45%), unstable/fractured spine (73%), and spinal stenosis (55%) but patients with radiculopathy had more asleep FOB (49%) (P<0.001). There was no association between method of intubation and postoperative airway complications. Acute postoperative airway obstruction occurred in 4 (1.2%) patients requiring reintubation. The technique of management of the airway for cervical spine surgery varied considerably among the anesthesiologists, although the choice was not associated with postoperative airway complications.

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

Reprints: Pirjo H. Manninen, MD, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada (e-mail:

Received for publication January 18, 2007; accepted March 21, 2007

© 2007 Lippincott Williams & Wilkins, Inc.