Airway management: Uncleared cervical spine injury

Abstract

The potential for cervical spine injury makes airway management more complex in the trauma patient. Patients with injury above the clavicles are at increased risk, and this is increased 4-fold if there is a clinically significant head injury (GCS < 9). Cervical vertebrae, being highly mobile for flexion, extension and rotation in vertebral column, are the most vulnerable ones for fracture, subluxation and dislocation. Atlanto-axial dislocation may even be fatal. In patients suspected for cervical spine instability, manipulation of airway either in emergency or electively continues to figure prominently challenging in anaesthesia practice. The best outcome depends upon the patients' predicament and the practitioner's experience and expertise with technique and the skills with which it is performed.

Keywords

• airway management
• cervical spine injury
• endotracheal tubes
• head injury