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Cited by 40Airway Management and Intubation TechniquesIntraoperative Neuromonitoring and Anesthetic EffectsCervical and Thoracic Myelopathy

Neurological deterioration during intubation in cervical spine disorders

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Durga, Padmaja, Sahu, BaradaPrasad·2014·Indian Journal of Anaesthesia
DOI 10.4103/0019-5049.147132PMC PMC4296351
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Abstract

Anaesthesiologists are often involved in the management of patients with cervical spine disorders. Airway management is often implicated in the deterioration of spinal cord function. Most evidence on neurological deterioration resulting from intubation is from case reports which suggest only association, but not causation. Most anaesthesiologists and surgeons probably believe that the risk of spinal cord injury (SCI) during intubation is largely due to mechanical compression produced by movement of the cervical spine. But it is questionable that the small and brief deformations produced during intubation can produce SCI. Difficult intubation, more frequently encountered in patients with cervical spine disorders, is likely to produce greater movement of spine. Several alternative intubation techniques are shown to improve ease and success, and reduce cervical spine movement but their role in limiting SCI is not studied. The current opinion is that most neurological injuries during anaesthesia are the result of prolonged deformation, impaired perfusion of the cord, or both. To prevent further neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and positioning for surgery are essential. The features that diagnose laryngoscopy induced SCI are myelopathy present on recovery, short period of unconsciousness, autonomic disturbances following laryngoscopy, cranio-cervical junction disease or gross instability below C3. It is difficult to accept or refute the claim that neurological deterioration was induced by intubation. Hence, a record of adequate care at laryngoscopy and also perioperative period are important in the event of later medico-legal proceedings.

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  • Even in patients with known cervical spine injuries, secondary neurologic deterioration is rare, with a reported incidence of 0.03%.

    “even in patients with known cervical spine injuries, secondary neurologic deterioration is rare, with a reported incidence of 0.03%.33,[37][38][39]”

    From Airway Management in Trauma (2018) · cites this paper as [37]

    In “Evidence of Cervical Injury Following Intubation” (page not available), the paper says approximately 5% of patients admitted with traumatic cervical injury deteriorate neurologically, not 0.03%. It separately describes published reports of deterioration associated with intubation as few, but gives no 0.03% incidence for patients with known cervical spine injuries. (LLM, conf=0.88)

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Authors
Durga, P., & Sahu, B.
Affiliations
Nizam's Institute of Medical Sciences (IN)
Corresponding author
Durga, Padmaja
ORCID
Durga, Padmaja
Venue
Indian Journal of Anaesthesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014
Volume
58
Issue
6
Pages
684
ISSN
0019-5049 (ISSN-L)
DOI
10.4103/0019-5049.147132
PMC
PMC4296351
OpenAlex
W2114233374
Cited by
40
References
0
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 8 · 2017: 3 · 2016: 2 · 2015: 1
FWCI
2.74
Type
journal article
Language
en
Open access
Licence
cc-by-nc-sa
Locations
  • Indian Journal of Anaesthesia (publishedVersion, cc-by-nc-sa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Surgery › Intraoperative Neuromonitoring and Anesthetic Effects
  • Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords
cervical spine disorders, spinal cord injury, difficult intubation, cervical spine movement, laryngoscopy, myelopathy, airway management, spinal cord perfusion, medico-legal aspects

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