Skip to main content

Advertisement

Springer Nature Link
Log in

The adult cervical spine: implications for airway management

  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. Using the Index Medicus as a guide, 30 years of medical literature were reviewed, with emphasis on the last ten years. Key words employed for this review are cited in the manuscript. Relevant papers were selected from anaesthetic, orthopaedic, rheumatologic, emergency medicine and trauma journals and reviewed. Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.

Résumé

Les anesthésistes sont responsables du maintien des voies aériennes chez les patients ayant des colonnes cervicales instables. Malheureusement la littérature anesthésique ne contient aucune analyse critique récente qui aide les anesthésistes à assurer les soins chez ces patients. Cette revue est volontairement faite pour combler cette lacune. Utilisant l’Index Medicus comme guide, 30 anneés de littérature médicale furent revues en mettant l’emphase surtout sur les dix derniéres années. Les mots-clés employés pour cette revue sont cités dans le manuscrit. Les papiers pertinents ont été sélectionnés, les journaux, l’anesthésie, l’orthopédie, de rhumatologie, de médecine d’urgence et de trauma et ont été revus. Les trouvailles pertinentes incluent la haute prévalence d’ instabilité cervicale dans les désordres tel que la Trisomie 21 et l’arthrite rhumatoïde et l’incidence relativement basse aprés trauma. Il y a des lacunes dans les approaches afin d’évaluer la colonne cervicale tel que la radiographie latérale à travers la table après trauma car cette méthode n ’ est ni sensible ni spécifique. Finalement, l’identification de l’instabilité cervicale et l’intubation avec précaution évitant les mouvements cervicaux apparaît plus important que le mode d’intubation pour presérver la fonction neurologique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cloward RB. Acute cervical spine injuries. Clin Symp 1980; 32: 3–32.

    Google Scholar 

  2. Moore KL. Clinically Oriented Anatomy. Baltimore: Williams and Wilkins, 1980; 610–38.

    Google Scholar 

  3. Sherk HH, Parke WW. Normal adult anatomy.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 8–22.

    Google Scholar 

  4. Bland JH. Anatomy and biomechanics.In: Disorders of the Cervical Spine. Philadelphia: W.B. Saunders Co., 1987; 9–63.

    Google Scholar 

  5. Jofe MH, White AA, Panjabi MM. Kinematics.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 23–35.

    Google Scholar 

  6. Ragozzino MW, Deluca SA. Upper cervical spine trauma. Am Fam Physician 1985; 32: 113–9.

    CAS  PubMed  Google Scholar 

  7. Nichol HC, Zuck D. Difficult laryngoscopy — the “anterior” larynx and the atlanto-occipital gap. Br J Anaesth 1983; 55: 141–4.

    Article  CAS  PubMed  Google Scholar 

  8. White A, Kander PL. Anatomical factors in difficult direct laryngoscopy. Br J Anaesth 1975; 47: 468–73.

    Article  CAS  PubMed  Google Scholar 

  9. Zuck D. Difficult tracheal intubation. Anaesthesia 1985; 40: 1016–7.

    Article  CAS  PubMed  Google Scholar 

  10. Hayashi H, Okada K, Hamada M, Tada K, Ueno R. Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. Clin Orthop 1987; 214: 200–9.

    PubMed  Google Scholar 

  11. White AA, Southwick WO, Panjabi MM. Clinical instability in the lower cervical spine. Spine 1976; 1: 15–27.

    Article  Google Scholar 

  12. Johnson RM, Wolf JW. Stability.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 35–53.

    Google Scholar 

  13. Hensinger RN. Congenital anomalies of the atlantoaxial joint.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 155–60.

    Google Scholar 

  14. Steel HH. Anatomical and mechanical considerations of the atlantoaxial articulations. J Bone Joint Surg 1968; 50: 1481–90.

    Google Scholar 

  15. White AA, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop 1975; 109: 85–95.

    Article  PubMed  Google Scholar 

  16. Poznanski AK. Congenital anomalies of the cervical spine.In: The Cervical Spine. Bailey RW (Ed.). Philadelphia: Lea & Febiger, 1974; 47–90.

    Google Scholar 

  17. Lipson SJ. Dysplasia of the odontoid process in Morquio’s syndrome causing quadriparesis. J Bone Joint Surg 1977; 59A: 340–4.

    Google Scholar 

  18. Herrick IA, Rhine EJ. The mucopolysaccharidoses and anaesthesia: a report of clinical experience. Can J Anaesth 1988; 35: 67–73.

    Article  CAS  PubMed  Google Scholar 

  19. Walts LF, Finerman G, Wyatt GM. Anaesthesia for dwarfs and other patients of pathological small stature. Can Anaesth Soc J 1975; 22: 703–9.

    Article  CAS  PubMed  Google Scholar 

  20. Mayhew JF, Katz J, Miner M, Leiman BC, Hall ID. Anaesthesia for the achondroplastic dwarf. Can Anaesth Soc J 1986; 33: 216–21.

    Article  CAS  PubMed  Google Scholar 

  21. Pueschel SM, Scola FH. Atlantoaxial instability in individuals with Down’s Syndrome: epidemiologic, radiographic and clinical studies. Pediatrics 1987; 80: 555–60.

    CAS  PubMed  Google Scholar 

  22. Moore RA, McNicholas KW, Warran SP. Atlantoaxial subluxation with symptomatic spinal cord compression in a child with Down’s syndrome. Anesth Analg 1987; 66: 89–90.

    Article  CAS  PubMed  Google Scholar 

  23. Williams JP, Somerville GM, Miner ME, Reilly D. Atlantoaxial subluxation and Trisomy-21: another perioperative complication. Anesthesiology 1987; 67: 253–4.

    Article  CAS  PubMed  Google Scholar 

  24. Kobel M, Creighton RE, Steward DJ. Anaesthetic considerations in Down’s Syndrome: experience with 100 patients and a review of the literature. Can Anaesth Soc J 1982; 29: 593–9.

    Article  CAS  PubMed  Google Scholar 

  25. Olive PM, Whitecloud TS, Bennett JT. Lower cervical spondylosis and myelopathy in adults with Down’s Syndrome. Spine 1988; 13: 781–4.

    Article  CAS  PubMed  Google Scholar 

  26. Pizzutillo PD. Klippel-Feil Syndrome.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 174–87.

    Google Scholar 

  27. Naguib M, Farag H, Ibrahim AEW. Anaesthetic considerations in Klippel-Feil Syndrome. Can Anaesth Soc J 1986; 33: 66–70.

    Article  CAS  PubMed  Google Scholar 

  28. Komusi T, Munro T, Harth M. Radiologic review: the rheumatoid cervical spine. Semin Arthritis Rheum 1985; 14: 187–95.

    Article  CAS  PubMed  Google Scholar 

  29. Calin A. The spondyloarthropathies.In: Scientific American Medicine: Rheumatology. New York; Scientific American, Inc. 1985.

    Google Scholar 

  30. Espada G, Babini JC, Maldanado-Cocco JA, Garcia-Morteo O. Radiologic review: the cervical spine in Juvenile Rheumatoid Arthritis. Semin Arthritis Rheum 1988; 17: 185–95.

    Article  CAS  PubMed  Google Scholar 

  31. Grantham SA. Rheumatoid arthritis and other noninfectious inflammatory diseases: atlantoaxial instability.In: The Cervical Spine. The Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 356–62.

    Google Scholar 

  32. Williams JrRC, McCarty DJ. Clinical picture of rheumatoid arthritis.In: McCarty DJ (Ed.). Arthritis and Allied Conditions, A Textbook of Rheumatology. Tenth edition. Philadelphia: Lea and Feibiger, 1985; 611.

    Google Scholar 

  33. Harris ED. Rheumatoid arthritis, the clinical spectrum.In: Kelley WN, Harris ED, Ruddy S, Sledge LB (Eds.). Textbook of Rheumatology. 2nd edition. Philadelphia: W.B. Saunders, 1985; 927–30.

    Google Scholar 

  34. Smith PH, Sharp J.Kellgren JH. Natural history of rheumatoid cervical subluxations. Ann Rheum Dis 1972; 31: 222–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Weissman BNW, Aliabadi P, Weinfeld MS, Thomas WH, Sosman JL. Prognostic features of atlantoaxial subluxation in rheumatoid arthritis patients. Radiology 1982; 114: 745–51.

    Article  Google Scholar 

  36. Mathews JA. Atlantoaxial subluxation in rheumatoid arthritis. Ann Rheum Dis 1969; 28: 260.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Pellicci PM, Ranawat CS, Tsairis P, Bryan WJ. A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg 1981; 63-A: 342–50.

    Google Scholar 

  38. Keenan MA, Stiles CM, Kaufman RL. Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis. Anesthesiology 1983; 58: 441–9.

    Article  CAS  PubMed  Google Scholar 

  39. Althoff B, Goldie IF. Cervical collars in rheumatoid atlanto-axial subluxation: a radiographic comparison. Ann Rheum Dis 1980; 39: 485–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Sinclair JR, Mason RA. Ankylosing spondylitis, the case for awake intubation. Anaesthesia 1984; 39: 3–11.

    Article  CAS  PubMed  Google Scholar 

  41. Broom MJ, Raycroft JF. Complications of fractures of the cervical spine in ankylosing spondylitis. Spine 1988; 13: 763–6.

    Article  CAS  PubMed  Google Scholar 

  42. Bohlman HH. Acute fractures and dislocations of the cervical spine. J Bone Joint Surg 1979; 61-A; 1119–42.

    Google Scholar 

  43. Podolsky SM, Hoffman JR, Pietrafesa CA. Neurological complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis. Ann Emerg Med 1983; 12: 578–80.

    Article  CAS  PubMed  Google Scholar 

  44. Connoly JF. Injuries of the cervical spine.In: Connoly JF (Ed.). The Management of Fractures and Dislocations. Volume 1. Philadelphia: W.B. Saunders, 1981; 259–398.

    Google Scholar 

  45. Kalsbeek WD, McLaurin RL, Harris BSH, Miller JD. National head and spinal cord injury survey: major findings. J Neurosurg 1980; 53: S19–31.

    Google Scholar 

  46. McSweeney T. Injuries of the cervical spine. Ann Roy Coll Surg Eng 1984; 66: 1–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Walter J, Doris PE, Shaffer MA. Clinical presentation of patients with acute cervical spine injuries. Ann Emerg Med 1984; 13: 512–5.

    Article  CAS  PubMed  Google Scholar 

  48. Bryson BL, Mulkey M, Mumford B, Schwedhelm M, Warren K. Cervical spine injury: incidence and diagnosis. J Trauma 1986; 26: 669.

    Article  Google Scholar 

  49. Bohlmann HH, Boada E. Fractures and dislocations of the lower cervical spine.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 232–67.

    Google Scholar 

  50. Frost E. Central nervous system trauma. Anaesthesiology Clinics of North America 1987; 5: 565–85.

    Google Scholar 

  51. Karbi OA, Caspari DA, Tator CH. Extrication, immobilization and radiologic investigation of patients with cervical spine injuries. Can Med Assoc J 1988; 139: 617–21.

    CAS  Google Scholar 

  52. Babcock JL. Cervical spine injuries. Arch Surg 1976; 111: 646–51.

    Article  CAS  PubMed  Google Scholar 

  53. Roaf R. A study of the mechanics of spinal injuries. J Bone Joint Surg 1960; 42B: 810–23.

    Google Scholar 

  54. Whitley JE, Forsyth HF. The classification of cervical spine injuries. A J R 1960; 83: 633–44.

    CAS  Google Scholar 

  55. Fraser A, Edmonds-Seal J. Spinal cord injuries. A review of problems facing the anaesthetist. Anaesthesia 1982; 37: 1084–98.

    Article  CAS  PubMed  Google Scholar 

  56. Pierce DS, Barr JS. Fractures and dislocations at the base of the skull and the upper cervical spine.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 196–232.

    Google Scholar 

  57. Cadoux CG, White JD, Hedberg MC. High-yield radiographic criteria for cervical spine injuries. Ann Emerg Med 1987; 16: 738–42.

    Article  CAS  PubMed  Google Scholar 

  58. MacKersie RC, Shackford SR, Garfin SR, Hoyt DB. Major skeletal injuries in the obtunded blunt trauma patient: a case for routine radiologic survey. J Trauma 1988; 28: 1450–4.

    Article  CAS  PubMed  Google Scholar 

  59. Williams CT, Bernstein TW, Jelenko C. Essentiality of lateral cervical spine radiographs. Ann Emerg Med 1981; 10: 198–204.

    Article  CAS  PubMed  Google Scholar 

  60. Bryson BL, Warren K, Schwedhlem M, Mumford B, Lenaghan PA. Trauma to the aging cervical spine. J Emerg Nurs1987; 13: 334–41.

    CAS  PubMed  Google Scholar 

  61. Jacobs LM, Schwartz R. Prospective analysis of acute cervical injury: a methodology to predict injury. Ann Emerg Med 1986; 15: 85–90.

    Google Scholar 

  62. Fischer RP. Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984; 13: 905–7.

    Article  CAS  PubMed  Google Scholar 

  63. Alker GJ, Oh YS, Leslie EV et al. Postmortem radiology of head and neck injuries in fatal traffic accidents. Radiology 1975; 114: 611–17.

    Article  CAS  PubMed  Google Scholar 

  64. Bucholz RW, Burkhead WZ, Graham W et al. Occult cervical spine injuries in fatal traffic accidents. J Trauma 1979; 19: 768–71.

    Article  CAS  PubMed  Google Scholar 

  65. Bivins HG, Ford S, Bezmalinovic Z, Price HM, Williams JL. The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine. Ann Emerg Med 1988; 17: 25–9.

    Article  CAS  PubMed  Google Scholar 

  66. Bachulis BL, Long WB, Hynes GD, Johnson MC. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 1987; 153: 473–7.

    Article  CAS  PubMed  Google Scholar 

  67. Talucci RC, Shaikh KA, Schwab CW. Rapid sequence induction with oral endotracheal intubation in the multiply injured patient. Am Surg 1988; 54: 185–7.

    CAS  PubMed  Google Scholar 

  68. Ross SE, Schwab CW, David ET, Delong WG, Born CT. Clearing the cervical spine: initial radiographic evaluation. J Trauma 1987; 27: 1055–60.

    Article  CAS  PubMed  Google Scholar 

  69. Gbaanador GBM, Fruin AH, Taylon C. Role of routine cervical radiography in head trauma. Am J Surg 1986; 152: 643–8.

    Article  CAS  PubMed  Google Scholar 

  70. O’Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma 1988; 28: 1476–8.

    Article  PubMed  Google Scholar 

  71. Grande CM, Barton RB, Stene JK. Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg 1988; 67: 714–5.

    Article  CAS  PubMed  Google Scholar 

  72. Reid DC, Henderson R.Saboe L, Miller JDR. Etiology and clinical course of missed spine fractures. J Trauma 1987; 27: 980–6.

    Article  CAS  PubMed  Google Scholar 

  73. Ringenberg BJ, Fisher AK, Urdaneta LF, Midthun MA. Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med 1988; 17: 792–6.

    Article  CAS  PubMed  Google Scholar 

  74. Streitwieser DR, Knopp R, Wales LR, Williams JL, Tonnemacher K. Accuracy of the standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 1983; 12: 538–42.

    Article  CAS  PubMed  Google Scholar 

  75. Hadden WA, Gillespie WJ. Multiple level injuries of the cervical spine. Injury 1985; 16: 628–33.

    Article  CAS  PubMed  Google Scholar 

  76. Miller MD, Gehweiler JA, Martinez S, Charlton OP, Daffner RH. Significant new observations on cervical spine trauma. AJR 1978; 130: 659–63.

    Article  CAS  PubMed  Google Scholar 

  77. Schaffer MA, Doris PE. Limitation of the cross table lateral view in detecting cervical spine injuries: a retrospective analysis. Ann Emerg Med 1981; 10: 508–13.

    Article  Google Scholar 

  78. Cadoux CG, White JD. High-yield radiographic considerations for cervical spine injuries. Ann Emerg Med 1986; 15: 236–9.

    Article  CAS  PubMed  Google Scholar 

  79. Freed HA, Shields NN. Most frequently overlooked radiographically apparent fractures in a teaching hospital emergency department. Ann Emerg Med 1984; 13: 900–4.

    Article  CAS  PubMed  Google Scholar 

  80. Williams CT, Bernstein TW, Jelenko C. Essentiality of the lateral cervical spine radiograph. Ann Emerg Med 1981; 10: 198–204.

    Article  CAS  PubMed  Google Scholar 

  81. Podolsky S, Barqff LJ, Simon RR, Hoffman JR, Larmon B, Ablon W. Efficacy of cervical spine immobilization methods. J Trauma 1983; 23: 461–5.

    Article  CAS  PubMed  Google Scholar 

  82. Riggins RS, Kraus JF. The risk of neurological damage with fractures of the vertebrae. J Trauma 1977; 17: 126–33.

    Article  CAS  PubMed  Google Scholar 

  83. Colachis SC, Strohm BR, Ganter EL. Cervical spine movement in normal women: radiographic study of the effect of cervical collars. Arch Phys Med Rehabil 1973; 54: 161–9.

    PubMed  Google Scholar 

  84. Wolf JW, Johnson RM. Cervical orthoses.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983; 54–61.

    Google Scholar 

  85. McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med 1986; 15: 93–6.

    Google Scholar 

  86. Cline JR, Scheeidel E, Bigsby EF. A comparison of methods of cervical immobilization used in patient extrication and transport. J Trauma 1985; 25: 649–53.

    Article  CAS  PubMed  Google Scholar 

  87. Graziano AF, Scheidel EA, Cline JR, Baer LJ. A radiographic comparison of prehospital cervical immobilization methods. Ann Emerg Med 1987; 16: 1127–31.

    Article  CAS  PubMed  Google Scholar 

  88. Majernick TG, Bieniek R, Houston JB, Hughes HG. Cervical spine movement during orotracheal intubation. Ann Emerg Med 1986; 15: 417–20.

    Article  CAS  PubMed  Google Scholar 

  89. Kaufman HH, Harris JH, Spencer JA, Kopansky DR. Danger of traction during radiography for cervical trauma. JAMA 1982; 247: 2369.

    Article  CAS  PubMed  Google Scholar 

  90. Aprahamian C, Thompson BM, Finger WA, Darin JC. Experimental cervical spine injury model: examination of airway management and splinting techniques. Ann Emerg Med 1984; 13: 584–7.

    Article  CAS  PubMed  Google Scholar 

  91. Gerlock AJ, Mirfakhraee M. Skull and cervical spine in the emergency department. Topics Emerg Med 1983; 5: 6–27.

    Google Scholar 

  92. Harris JH Jr,Edeiken-Monroe B. The radiology of acute cervical spine trauma. 2nd ed. Baltimore: Williams and Wilkins, 1987.

    Google Scholar 

  93. Clark CR, Igram CM, El-Khoury, Ehara S. Radiographic evaluation of cervical spine injuries. Spine 1988; 13: 742–7.

    Article  CAS  PubMed  Google Scholar 

  94. Penning L. Obtaining and interpreting plain films in cervical spine injury.In: The Cervical Spine. Cervical Spine Research Society. Philadelphia: J.B. Lippincott, 1983: 62–95.

    Google Scholar 

  95. Weir DC. Roentgenographic signs of cervical injury. Clin Orthop 1975; 109: 9–17.

    Article  PubMed  Google Scholar 

  96. Christenson PC. The radiologic study of the normal spine: cervical, thoracic, lumbar, and scaral. Radiol Clin North Am 1977; 15: 133–54.

    CAS  PubMed  Google Scholar 

  97. Nichols CG, Young DH, Schiller WR. Evaluation of cervicothoracic junction injury. Ann Emerg Med 1987; 16: 640–2.

    Article  CAS  PubMed  Google Scholar 

  98. Gopalakrishnan KC, Masri WE. Pre-vertebral soft tissue shadow widening — an important sign of cervical spine injury. Injury 1986; 17: 125–8.

    Article  CAS  PubMed  Google Scholar 

  99. Juhl JH. Essentials of roentgen interpretation. 4th edition. Philadelphia: Harper and Rowe, 1981; 150–2.

    Google Scholar 

  100. Blahd WH, Iserson KV, Bjelland JC. Efficacy of the posttraumatic cross table lateral view of the cervical spine. J Emerg Med 1985; 2: 243–9.

    Article  PubMed  Google Scholar 

  101. Mace SE. Emergency evaluation of cervical spine injuries: CT versus plain radiographs. Ann Emerg Med 1985; 14: 973–5.

    Article  CAS  PubMed  Google Scholar 

  102. Wales LR, Knopp RK, Morishima MS. Recommendations for evaluation of the acutely injured cervical spine: a clinical radiologic algorithm. Ann Emerg Med 1980; 9: 422–8.

    Article  CAS  PubMed  Google Scholar 

  103. Bouget D, Boukobza M, Metzger M, Roy-Camille R, Viars P. Difficult intubation for cervical spine surgery; airway assessment with magnetic resonance imaging. Anesthesiology 1988; 69: A725.

    Article  Google Scholar 

  104. Vicario SJ, Coleman R, Cooper MA, Thomas DM. Ventilatory status early after head injury. Ann Emerg Med 1983; 12: 145–8.

    Article  CAS  PubMed  Google Scholar 

  105. Danzel DF, Thomas DM. Nasotracheal intubations in the emergency department. Crit Care Med 1980; 8: 677–82.

    Article  Google Scholar 

  106. Giuffrida JG, Bizzari DV, Latteri FS et al. Prevention of major airway complications during anesthesia by intubation of the conscious patient. Anesth Analg 1960; 39: 201–11.

    Article  CAS  PubMed  Google Scholar 

  107. Gold MI, Buechel DR. A method of blind nasal intubation for the conscious patient. Anesth Analg 1960; 39: 257–63.

    Article  CAS  PubMed  Google Scholar 

  108. Kapp JP. Endotracheal intubation in patients with fractures of the cervical spine. J Neurosurg 1975; 42: 731–2.

    Article  CAS  PubMed  Google Scholar 

  109. Messeter KH, Pettersson KI. Endotracheal intubation with the fibre-optic bronchoscope. Anaesthesia 1980; 35: 294–8.

    Article  CAS  PubMed  Google Scholar 

  110. Rogers SN, Benumof JL. New and easy techniques for fiberoptic-aided tracheal intubation. Anesthesiology 1983; 59: 569–72.

    Article  CAS  PubMed  Google Scholar 

  111. Hemmer D, Lee T, Wright BD. Intubation of a child with a cervical spine injury with the aid of a fibreoptic bronchoscope. Anaesth Intensive Care 1982; 10: 163–5.

    CAS  PubMed  Google Scholar 

  112. McNamara RM. Retrograde intubation of the trachea. Ann Emerg Med 1987; 16: 680–2.

    Article  CAS  PubMed  Google Scholar 

  113. Riou B, Barriot P, Bodenan P, Viars P. Retrograde tracheal intubation in trauma patients. Anesthesiology 1987; 67: A130.

    Article  Google Scholar 

  114. Kress TD, Balasubramanian S. Cricothyrodotomy. Ann Emerg Med 1982; 11: 197–201.

    Article  CAS  PubMed  Google Scholar 

  115. McGill J, Clinton JE, Ruiz E. Cricothyrotomy in the emergency department. Ann Emerg Med 1982; 11: 361–4.

    Article  CAS  PubMed  Google Scholar 

  116. Sosis M, Possanza C. Anaesthesia for the patient with the unstable neck. Anaesth Intensive Care 1986; 14: 328–4.

    CAS  PubMed  Google Scholar 

  117. Meschino A, Devitt JH, Schwartz ML, Koch JP. The safety of awake tracheal intubation in cervical spine injury. Can J Anaesth 1988; 35: S131–2.

    Google Scholar 

  118. Jacoby J. Nasal endotracheal intubation by an external visual technic. Anesth Analg 1970; 49: 731–9.

    Article  CAS  PubMed  Google Scholar 

  119. Doolan LA, O’Brien JF. Safe intubation in cervical spine injury. Anaesth Intensive Care 1985; 13: 319–24.

    CAS  PubMed  Google Scholar 

  120. Pepe PE, Copass MK, Joyce TH. Prehospital endotracheal intubation: rationale for training emergency medical personnel. Ann Emerg Med 1985; 14: 1085–92.

    Article  CAS  PubMed  Google Scholar 

  121. Dinner M, Tjeuw M, Artusio JF. Bacteremia as a complication of nasotracheal intubation. Anesth Analg 1987; 66: 460–2.

    Article  CAS  PubMed  Google Scholar 

  122. Layman PR. An alternative to blind nasal intubation. Anaesthesia 1983; 38: 165.

    Article  CAS  PubMed  Google Scholar 

  123. Walters FJM, Nott MR. The hazards of anaesthesia in the injured patient. Br J Anaesth 1977; 49: 707–20.

    Article  CAS  PubMed  Google Scholar 

  124. Ovassapian A, Yelich SJ, Dykes MHM, Brunner EE. Fibreoptic nasotracheal intubation — incidence and causes of failure. Anesth Analg 1983; 62: 692–5.

    CAS  PubMed  Google Scholar 

  125. Advanced Trauma Life Support Course for Physicians Manual. 1984 American Coll Surgeons. 7–13.

  126. Joyce SM. Cervical immobilization during orotracheal intubation in trauma victims. Ann Emerg Med 1988; 17: 88.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesia, Women’s College Hospital, 76 Grenville Street, M5S 1B2, Toronto, Ontario, Canada

    Edward T. Crosby

  2. Department of Anesthesiology, Virginia Mason Hospital, 98111, Seattle, Washington, USA

    Anne Lui

Authors
  1. Edward T. Crosby
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Anne Lui
    View author publications

    You can also search for this author inPubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Crosby, E.T., Lui, A. The adult cervical spine: implications for airway management. Can J Anesth 37, 77–93 (1990). https://doi.org/10.1007/BF03007488

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03007488

Key words