Abstract:
PURPOSE:Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors related to initial management, diagnosis, airway and anesthetic management of patients with CSI are presented. SOURCE:Medline search was performed to seek out the English-language literature using the following phrases and keywords: spine trauma; cervical spine; airway management after CSI. PRINCIPAL FINDINGS:Cervical spine injury occurs in up to 3% to 6% of all patients with trauma. The initial management of a patient with potential spine injury requires a high degree of suspicion for CSI so that early stabilization of the spine can be used to prevent further neurological damage. Diagnostic radiology has a critical role to play; however, clinical evaluation is equally important in excluding CSI in a conscious and cooperative patient. Although in-line stabilization reduces the movement at C-spine, traction causes clinically significant distraction and should be avoided. CONCLUSION:A high level of suspicion and anticipation are the major components of decision making and management in a patient with CSI. Endotracheal intubation using the Bullard laryngoscope may have some advantages over other techniques as it causes less head and C-spine extension than the conventional laryngoscope, and this results in a better view. However, the current opinion is that oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI. In summation caution, close care and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Ghafoor AU,Martin TW,Gopalakrishnan S,Viswamitra Sdoi
10.1016/j.jclinane.2005.04.003subject
Has Abstractpub_date
2005-12-01 00:00:00pages
640-9issue
8eissn
0952-8180issn
1873-4529pii
S0952-8180(05)00237-0journal_volume
17pub_type
杂志文章,评审abstract::Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variati...
journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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journal_title:Journal of clinical anesthesia
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