Interesting discussion on intubation for cervical surgery

[mmglobal]

Over on braintalk... someone posted an interesting question that brought out some good info from Dr. W.

Here is a link to the thread...

Originally Posted by Patricia228

Last Tuesday I had my pre-admin work done...4 hours of poking, proding, questions and pictures. However, I was impressed with the level of care I received from everyone at the hospital. I left there feeling better and a little less fearful of surgery. Many of the specialists I talked to that day made a point of telling me that the surgeon I was having was excellent. I never asked, they just told me that.....maybe I had a lot of fear in my eyes. Anyway, one comment by the anesthetist (yeah, not really sure how to spell that) left me with some fear. He told me that the couldn't do a normal intubation because they can't tip my head back due to the cord compression. He explained the process that they would use and he also explained that all the anesthetists are very familiar with it since this hospital specializes in spinal cord injury. The concern for me is that they sometimes do it while the patient is still awake. They use a local anesthetic, but they keep the patient awake to ensure movement of the neck is minimal and all fingers and toes are still wiggling once they're done and before they put you to sleep. Okay....anyone else know about this?

Originally Posted by algosdoc

Awake intubations are those in which local anesthesia is administered as in injection around the cords and/or the pharynx is anesthetized with spray local anesthesia in the form of cetacaine or a nebulized lidocaine. Patients absolutely positively are never given skeletal muscle relaxants or paralyzed for this procedure since the whole point is to insure cord functional continuity that requires patient cooperation. These awake intubations can be performed using a variety of techniques including in order of commonality: fiberoptic intubation, Wooscope intubation, LMA Fastrack intubation, fiberoptic light wand, and retrograde wire techniques. The technique can be very easy or not so easy depending on the skills of the anesthesiologist (make sure you do not get a CRNA doing this procedure...it absolutely should be an anesthesiologist for the actual intubation and I would insist on this point!), the patient tolerance for sedatives, hypersensitivity of the airway and the ability to adequately anesthetize the airway before the procedure, and the difficulty of the anatomy.

[fortitudine]

This is a very interesting post to me since I am in the same boat. Yet I've never heard of this before. What kind of intubation does Dr. Bertagnoli do for patients with cord compression? Is this a terrifying procedure for the patient? I can't conceive of what it must be like. I'd think they'd have to tie me down.

I hope Mark or others who have had c-spine ADR with osteophytes and cord compression will weigh in on this.

[fortitudine]

I responded to Mark's post but no one else has so I'm starting a new one. Does anyone know what it's like to have awake intubation?

Does Dr. Bertagnoli do that with his cervical patients who have cord compression??

[mmglobal]

Hope,

I'm sorry that your question got missed. I hope you don't mind that I merged your new thread into the existing thread. That will make it easier for folks to find the info in the future.

I have been in Germany with one patient who's cervical issues were so profound that they were not comfortable using normal intubation technique. What I remember is that they used nasal intubation. I do not know if the patient was awake for the intubation, but I believe it was not awake.

Please note that the issues surrounding awake intubation and what I remember for this client may be different. Intubation technique is not something I focus on and while I have seen it on several occasions, I'm not usually present for that. Their techniques may change or evolve. While I'm happy to share what my experience has been, questions surrounding issues like these should be directed to the docs involved.

All the best... talk to you soon,

Mark