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Cervical spine injury intubation

Jung-In Ko, Sang Ook Ha, Min Seok Koo, Miyoung Kwon, Jieun Kim, Jin Jeon, So Hee Park, Sangwoo Shim, Youjin Chang, Taejin Park
OBJECTIVE: Airway management in patients with suspected cervical spine injury is classified as a "difficult airway." The best device for managing difficult airways is not known. Therefore, we conducted an intubation study simulating patients with cervical spine injury using three devices: a conventional Macintosh laryngoscope, a video laryngoscope (GlideScope), and a fiberoptic bronchoscope (MAF-TM). Success rates, intubation time, and complication rates were compared. METHODS: Nine physician experts in airway management participated in this study...
December 2015: Clin Exp Emerg Med
Brian E Driver, David Plummer, William Heegaard, Robert F Reardon
BACKGROUND: The King LT airway (King Systems, Noblesville, IN) is a popular extraglottic device that is widely used in the prehospital setting. We report a case of tracheal malplacement of the King airway with a severe kink in the distal tube. CASE REPORT: A 51-year-old unhelmeted motorcyclist collided with a freeway median and was obtunded when paramedics arrived. After bag mask ventilation, a King airway was placed uneventfully and the patient was transported to the emergency department...
September 17, 2016: Journal of Emergency Medicine
Simon Sulser, Dirk Ubmann, Martin Schlaepfer, Martin Brueesch, Georg Goliasch, Burkhardt Seifert, Donat R Spahn, Kurt Ruetzler
BACKGROUND: Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. OBJECTIVE: The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting...
August 16, 2016: European Journal of Anaesthesiology
G V Oosthuizen, J L Bruce, W Bekker, N Shangase, G L Laing, D L Clarke
BACKGROUND: Pan computed tomography (CT) is widely used in the evaluation of patients with blunt polytrauma, but there is growing concern about the radiation risks imposed. OBJECTIVE: To ascertain whether we were possibly overutilising pan CT in our trauma service, and whether we could safely cut down on scans without missing significant injuries. METHODS: We audited all pan scans performed in the Metropolitan Trauma Service, Pietermaritzburg, South Africa, during the 12-month period 1 January - 31 December 2012...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Kotaro Sorimachi, Yuko Ono, Hideo Kobayashi, Kazuyuki Watanabe, Kazuaki Shinohara, Koji Otani
BACKGROUND: Penetrating neck injury is an important trauma subset but is relatively rare, especially when involving the posterior cervical column. Rupture of the neck restraints, including the interspinous and flavum ligaments, can create serious cervical instability that requires special consideration when managing the airway. However, no detailed information regarding airway management in patients with profound posterior neck muscle laceration and direct cervical ligament disruption by an edged weapon is yet available in the literature...
2016: Journal of Medical Case Reports
Bradley J Hindman, Ricardo B Fontes, Robert P From, Vincent C Traynelis, Michael M Todd, Christian M Puttlitz, Brandon G Santoni
OBJECTIVE With application of the forces of intubation, injured (unstable) cervical segments may move more than they normally do, which can result in spinal cord injury. The authors tested whether, during endotracheal intubation, intervertebral motion of an injured C3-4 cervical segment 1) is greater than that in the intact (stable) state and 2) differs when a high- or low-force laryngoscope is used. METHODS Fourteen cadavers underwent 3 intubations using force-sensing laryngoscopes while simultaneous cervical spine motion was recorded with lateral fluoroscopy...
May 27, 2016: Journal of Neurosurgery. Spine
Ehab Farag
Cervical spine surgery is one of the most commonly performed spine surgeries in the United States, and 90% of the cases are related to degenerative cervical spine disease (the rest to cervical spine trauma and/or instability). The airway management for cervical spine surgery represents a crucial step in the anesthetic management to avoid injury to the cervical cord. The crux for upper airway management for cervical spine surgery is maintaining the neck in a neutral position with minimal neck movement during endotracheal intubation...
March 2016: Best Practice & Research. Clinical Anaesthesiology
Dawid Aleksandrowicz, Tomasz Gaszyński
Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F = 26, M = 14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed...
2016: BioMed Research International
Divya Jain, Indu Bala, Komal Gandhi
BACKGROUND: Videolaryngoscopes are increasingly being used in potentially difficult airway. McCoy laryngoscope provides definitive advantage over conventional laryngoscopes in cervical spine patients. The aim of this study was to compare the performance of the CMAC(®) videolaryngoscope with the McCoy Laryngoscope in patients with a cervical collar. MATERIAL AND METHODS: Sample size of at least 22 patients in each group was calculated using Intubation Difficulty Scale (IDS) score as the primary outcome...
January 2016: Journal of Anaesthesiology, Clinical Pharmacology
Pooja Chopra, Madhu Bala Dixit, Aashish Dang, Vibhuti Gupta
BACKGROUND AND AIMS: We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients. MATERIAL AND METHODS: In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX...
January 2016: Journal of Anaesthesiology, Clinical Pharmacology
Sangeeta Dhanger, Suman Lata Gupta, Stalin Vinayagam, Prasanna Udupi Bidkar, Lenin Babu Elakkumanan, Ashok Shankar Badhe
BACKGROUND: Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation. AIMS: The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation. SETTINGS AND DESIGN: In this study, 200 patients belonging to age group 18-60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled...
January 2016: Anesthesia, Essays and Researches
P K Hyldmo, M B Horodyski, B P Conrad, D N Dubose, J Røislien, M Prasarn, G R Rechtine, E Søreide
BACKGROUND: Endotracheal intubation is not always an option for unconscious trauma patients. Prehospital personnel are then faced with the dilemma of maintaining an adequate airway without risking deleterious movement of a potentially unstable cervical spine. To address these two concerns various alternatives to the classical recovery position have been developed. This study aims to determine the amount of motion induced by the recovery position, two versions of the HAINES (High Arm IN Endangered Spine) position, and the novel lateral trauma position (LTP)...
August 2016: Acta Anaesthesiologica Scandinavica
Nitesh Gill, Shobha Purohit, Poonam Kalra, Tarun Lall, Avneesh Khare
BACKGROUND: Intubation is known to cause an exaggerated hemodynamic response in the form of tachycardia, hypertension, and dysrhythmias. In cervical spine instability, intubation has to be performed using cervical immobilization to prevent exacerbation of spinal cord injuries. Application of rigid cervical collar may reduce cervical spine movements, but it hinders tracheal intubation with a standard laryngoscope. The aim of this study was to compare the hemodynamic responses to fiberoptic bronchoscope (FOB) and McCoy laryngoscope in patients undergoing elective surgery under general anesthesia with rigid cervical collar simulating cervical spine immobilization in the situation of cervical trauma...
September 2015: Anesthesia, Essays and Researches
Heon Jin Choo, Oh Young Kwon, Young Gwan Ko
PURPOSE: The purpose of this study is to determine the educational suitability of the video-laryngoscope in teaching endotracheal intubation to students. METHODS: Medical students participated in a course on the use of a Macintosh direct laryngoscope and McGrath MAC videolaryngoscope for intubation. The course comprised a 1-hour lecture and 30 minutes of practice on a manikin. After the course, in each of the three simulated patient scenarios-normal airway, cervical spine fixation, and tongue edema-time to intubate, success rate, and chance of complications were measured...
December 2015: Korean Journal of Medical Education
John K Yue, Pavan S Upadhyayula, Andrew K Chan, Ethan A Winkler, John F Burke, William J Readdy, Sourabh Sharma, Hansen Deng, Sanjay S Dhall
INTRODUCTION: Spinal cord injury (SCI) is a debilitating disease with an average annual incidence of 29.5 persons per million worldwide. Hence, it is critical to refine and bolster evidence to inform standards of care and improve outcomes. EVIDENCE ACQUISITION: In 2013 the American Association of Neurological Surgeons and the Congress of Neurological Surgeons released updated management guidelines for acute cervical spine injuries and SCI; here, we explore cervical SCI treatment trials since the 2013 publication...
December 2016: Journal of Neurosurgical Sciences
Nilesh Kumar, Ashish Bindra, Charu Mahajan, Naveen Yadav
Traumatic cervical lesions compressing the spinal cord pose a significant risk of exacerbating the existing neurological condition during tracheal intubation and subsequent positioning. Preexisting ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient with traumatic cervical spinal cord. To improve ease and success, and reduce cervical spine movement, awake fibreoptic intubation (FOI) is considered the gold standard technique for airway management in such cases...
July 2015: Saudi Journal of Anaesthesia
Michal Barak, Hany Bahouth, Yoav Leiser, Imad Abu El-Naaj
According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult...
2015: BioMed Research International
Ryan T Whitesell, Scott D Steenburg, Changyu Shen, Hongbo Lin
OBJECTIVE: The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS: The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied...
July 2015: AJR. American Journal of Roentgenology
Lynette J Mark, Kurt R Herzer, Renee Cover, Vinciya Pandian, Nasir I Bhatti, Lauren C Berkow, Elliott R Haut, Alexander T Hillel, Christina R Miller, David J Feller-Kopman, Adam J Schiavi, Yanjun J Xie, Christine Lim, Christine Holzmueller, Mueen Ahmad, Pradeep Thomas, Paul W Flint, Marek A Mirski
BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland...
July 2015: Anesthesia and Analgesia
Michael J Malcharek, Manuel Bartz, Birgit Rogos, Lutz Günther, Armin Sablotzki, Jochen Gille, Gerhard Schneider
BACKGROUND: Two methods of topical anaesthesia for awake fibreoptic intubation (FOI) in patients at risk of secondary cervical injury were compared: the translaryngeal injection (TLI) technique and the Enk Fibreoptic Atomizer. OBJECTIVE: The objective of this study was to determine which system of topical anaesthesia provides the fastest and most comfortable awake FOI, using the oral approach. DESIGN: A randomised controlled study. SETTING: A single centre trial between 2009 and 2011...
September 2015: European Journal of Anaesthesiology
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