Airway management in patients with cervical instability: a challenge for the anesthesiologist
DOI:
https://doi.org/10.30445/rear.v14i8.1127Keywords:
Cervical instability, spinal injury, cervical trauma, cervical immobilization, manual online stabilization, difficult airwayAbstract
Cervical spine injury occurs in 3-4% of trauma patients, out of which 25% have a cervical spinal cord injury. Airway management has inherent risks in patients with cervical injury, whether the instability is previously known or not, since even the simplest maneuvers can displace the injured cervical spine. The action guidelines recommend manual stabilization in line together with laryngoscopy to minimize cervical displacement, as well as the use of transglottic devices to resolve worsening of the Cormack-Lehane grade. However, given the limited evidence of the efficacy of the MILS maneuver in minimizing cervical spinal movement and its association with side effects, together with the high prevalence of patients with difficult airways and the great technological development that has occurred in recent years, has led to the approach of new alternatives for airway management in these situations. Therefore, immobilization of the cervical spine through manual in-line stabilization is increasingly controversial and optical devices are increasingly used.
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