Reference : Management of the unstable cervical spine: elective versus emergent cases.
Scientific journals : Article
Human health sciences : Neurology
Human health sciences : Anesthesia & intensive care
http://hdl.handle.net/2268/11315
Management of the unstable cervical spine: elective versus emergent cases.
English
Bonhomme, Vincent mailto [Centre Hospitalier Universitaire de Liège - CHU > > Anesthésie et réanimation >]
Hans, Pol [Centre Hospitalier Universitaire de Liège - CHU > > Anesthésie et réanimation >]
2009
Current Opinion in Anaesthesiology
Lippincott Williams & Wilkins
22
5
579-85
Yes (verified by ORBi)
International
0952-7907
1473-6500
Philadelphia
PA
[en] elective case ; emergency ; management ; unstable cervical spine
[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.
http://hdl.handle.net/2268/11315
10.1097/ACO.0b013e32832e7adb

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