Airway management after cervical spine surgery

 

tl;dr:

·         Oedema +++

·         Difficult intubation+++

·         Failed extubation +++

·         Disasters often occur late (PACU, ward)

 

Causes of airway disaster after surgery:

Haematoma

·      Early

·      (esp thyroid, carotid surgery)

Oedema

·      Later

·      (esp C-spine surgery)

Abscess

·      Much later

Other

·      e.g. CSF leak

 

Risk factors for disaster:

More swelling

Big surgery

·      A+P approach

·      Multiple levels

·      Long duration

·      Lots of bleeding

More consequential

·      High vertebral level (above C4)

·      Stiff spine

·      Myelopathy

·      OSA

·      Lung disease

 

Recognising imminent disaster:

·         Stridor

·         Distress

·         Dyspnoea

·         Dysphonia

·         Dysphagia

·         Swollen face

 

Mitigating risk:

Intubation

·      Asleep VL

·      Better still, awake FOI

Extubation

·      Check for cuff leak

·      Better still, send to ICU intubated

 

 

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