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Canadian Journal of Anesthesia, Vol 39, 114-117, Copyright © 1992 by Canadian Anesthesiologists' Society

ARTICLES

The safety of awake tracheal intubation in cervical spine injury

A Meschino, JH Devitt, JP Koch, JP Szalai and ML Schwartz
Department of Anaesthesia, Sunnybrook Health Science Centre, University of Toronto, Ontario.

As a referral centre for cervical spine injuries, we have routinely performed awake tracheal intubation when intubation was indicated. A retrospective case control study was undertaken to review the frequency of neurological deterioration and aspiration associated with our approach. Neurological deterioration was assessed by a change in level of injury or neurological grade at admission and discharge. Four hundred and fifty-four patients with critical cervical spine and/or cord injuries were reviewed over an eight-year period. A case group of 165 patients underwent tracheal intubation awake within two months of injury. A control group of 289 remained unintubated during the same period. A comparison of spinal neurological status between admission and discharge revealed no statistically significant difference in neurological deterioration between the two groups. This occurred despite a greater injury severity score in the case group. No evidence of aspiration during intubation was documented. We conclude that awake tracheal intubation is a safe method of airway management in patients with cervical spine injuries.


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Copyright © 1992 by the Canadian Anesthesiologists' Society.