Airway management in cervical spine disease - Observations from a tertiary care hospital

Introduction: Airway management in patients with pre- existing cervical spine disease carries potential for further injury and requires careful consideration. Different studies have highlighted the anatomic considerations of different airway techniques. Generally, awake fiberoptic intubation is considered Gold Standard. We sought to study the airway management methods employed in patients presenting for cervical spine surgery at a tertiary care hospital and their impact. Methods: We conducted a retrospective observational study at a tertiary care hospital in Qatar as part of an institutional audit. Consecutive cases with cervical spine disease posted for elective spine surgery between July 2012 and December 2014 were observed for type of airway management technique, anesthetic used and signs of immediate post- operative neurological deterioration or any change in status from baseline. Results: A total of 98 patients met the inclusion criteria. 3 were excluded due to lack of data. 85% were males and 15% females. 55% had traumatic cervical spine disease and 34% degenerative cervical spine disease. 61 patients had preoperative motor weakness. For airway management, 56/95 patients underwent awake techniques (55 flexible fiberoptic; 1 Glidescope) with majority opting for remifentanyl plus propofol infusion (21/56) or TCI remifentanyl (18/56) for sedation. Remaining 39 patients were anesthetized before intubation. Only 2 patients developed neurologic deterioration after surgery. Conclusions: Majority of anesthetists had opted for awake fiberoptic technique. Progressive neurologic deterioration after surgery, occurred in only 2.1% of patients. No particular technique has conclusively shown superiority over others. Familiarity with a particular technique and good team communication is recommendable.