Airway management after cervical spine surgery

 

Summary:

        Problems: oedema + immobility

        Risks: difficult intubation + failed extubation

        Beware the delayed airway disaster

 

Risk factors:

More swelling

     A+P approach

     Multiple levels

     Long duration (>5 hours)

     Lots of bleeding (>300mL)

More consequential

     High vertebral level (above C4)

     Stiff spine

     Myelopathy

     OSA

     Lung disease

 

Recognition:

        Stridor

        Distress

        Dyspnoea

        Dysphonia

        Dysphagia

        Swollen face

 

Mitigating risk:

Intubation

     Video laryngoscopy

     Awake intubation

Extubation

     Cuff leak test

     ICU observation

     Extubate tomorrow

 

 

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