Management of the unstable cervical spine: elective versus emergent cases.

[en] PURPOSE OF REVIEW: The present review focuses on similarities and discrepancies in the management of emergent and elective unstable cervical spine (C-spine) patients. RECENT FINDINGS: During mobilization, lifting is superior to rolling in limiting spine movements. Before prone position surgery, the transfer of the patient on a rotating table is preferable to rolling. In trauma patients, helical computed tomography (CT) with sagittal reconstruction is the first choice for clearing the C-spine. In those patients, airway compromise may be related to hidden cervical edema or hematoma. Several devices can be of help in performing safe tracheal intubation in patients with limited neck movements, but awake fiberoptic intubation remains the safest procedure. The muscle relaxant antagonist sugammadex can improve safety for rapid sequence induction. It can rapidly reverse profound steroid-based neuromuscular blockade and allows avoidance of succinylcholine in this indication. Propofol anesthesia better prevents coughing upon emergence than inhaled anesthesia. Neuroprotection in cord-damaged patients is disappointing, and the controversy on the efficacy of high-dose methylprednisolone is not closed. Nevertheless, maintenance of homeostasis remains the cornerstone of neuroprotection. SUMMARY: Subtle details differentiate the management of emergent and elective unstable C-spine patients. In both situations, the presence or the absence of a neurological insult governs the therapeutic strategy.

Disciplines :

Anesthesia & intensive care
Neurology

Author, co-author :

Bonhomme, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Hans, Pol ; Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation

Language :

English

Title :

Management of the unstable cervical spine: elective versus emergent cases.

Publication date :

2009

Journal title :

Current Opinion in Anaesthesiology

ISSN :

0952-7907

eISSN :

1473-6500

Publisher :

Lippincott Williams & Wilkins, Philadelphia, United States - Pennsylvania

Volume :

Issue :

Pages :

579-85

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 21 January 2010

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Bibliography

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