Airway management of patients with traumatic brain injury/C-spine injury.
10.4097/kjae.2015.68.3.213
- Author:
Jin Yong JUNG
1
Author Information
1. Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. jychung@cu.ac.kr
- Publication Type:Review
- Keywords:
Airway management;
Cervical cord;
Intubation;
Traumatic brain injury
- MeSH:
Airway Management*;
Analgesics;
Brain Injuries;
Brain*;
Humans;
Intracranial Pressure;
Intubation;
Intubation, Intratracheal;
Laryngoscopes;
Mouth;
Spine;
Vocal Cords
- From:Korean Journal of Anesthesiology
2015;68(3):213-219
- CountryRepublic of Korea
- Language:English
-
Abstract:
Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope(R) (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope(R) also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury.
