SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof....
-
Upload
sophie-dole -
Category
Documents
-
view
230 -
download
0
Transcript of SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof....
![Page 1: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/1.jpg)
SPINAL CORD INJURIESSURGERY ON THE CERVICAL SPINE
Dr. UmakanthDr. Prabhu
Moderator : Prof. Rajeshwari
![Page 2: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/2.jpg)
Introduction
• AnaesthesiologistResuscitation + management of trauma victims
• High index of suspicion
• Evaluation of C-spine
• Understanding the pathophysiology of SCI
• Evaluating the risks and benefts of various airway appliances
![Page 3: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/3.jpg)
![Page 4: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/4.jpg)
Epidemiology
• Age 15-35 years and >65 years (peak incidence)
• C.spine injuries- 1.8% of all trauma cases
• 20% more than one cervical spine fracture
• 20-70% unstable
• 30-70% associated neurological injury
• 3-25% of SCI are iatrogenic i.e. during field stabilization, transit or early management
![Page 5: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/5.jpg)
Causes
• Motor vehicle accidents 50%
• Fall 20%
• Sports 15%
• Acts of violence 15%
Waters et al, spinal cord 1996
![Page 6: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/6.jpg)
Mechanisms
• Hyper flexion
• Hyperextension
• Compression
• Rotation
• Combined
![Page 7: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/7.jpg)
Hyper flexion
• Compression,
subluxation or
fracture dislocation
• Disruption of
posterior
longitudinal
ligament (PLL)
![Page 8: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/8.jpg)
Hyperextension
• Result from frontal / facial
trauma
• Most common in cervical
region
• Reduce AP diameter of
spinal canal
• Disruption of anterior
longitudinal ligament (ALL)
• Damage to vertebral
arteries
![Page 9: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/9.jpg)
Compression
• Result from forces
containing axial load
• Wedge compression and
burst fracture
• Serious damage due to
retropulsion of bone
• Most common in
thoracolumbar region
![Page 10: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/10.jpg)
Rotation
• All parts of vertebral body and disc
• ‘Locked facets’- due to flexion rotation
• Most often seen in C5-C7
![Page 11: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/11.jpg)
Combined
• Mainly cervical
region
• Whiplash injury
– Rapid acceleration –
decelaration forces
extreme
extension followed
by flexion
![Page 12: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/12.jpg)
Pathophysiology
• Primary insult : direct injury
• Secondary insult: inflammation, edema,
microhemorrhages ,and diminished capillary blood flow to spinal cord at risk.
-free radicals
-vascular mechanism -apoptosis
![Page 13: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/13.jpg)
Pathophysiology
![Page 14: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/14.jpg)
Management of SCI
Goals
- To suspect C-spine injury
-To look for clinical pointers
– Protect spinal cord from further injury
– Indicators for securing airway
– Ensure hemodynamic stability
– Neuroprotection
– Attention to other injuries (thoracic,
faciomaxillary )
![Page 15: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/15.jpg)
NEXUS criteria
• No midline cervical tenderness.
• No focal neurological deficit
• Normal alertness.
• No intoxication.
• No painful distracting injury.
![Page 16: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/16.jpg)
Maintain immobilisation and proceed with cervical x rays
Films adequate Not adequate(C1 –T1 Visible) Consider repeating exam with swimmers and oblique view or CT Scan Normal Abnormality
C-spine cleared Maintain cervical immobiolisation and get CT Scan
![Page 17: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/17.jpg)
Immobilization method
• No gold standard
• Soft collar
• Hard collar
• Short boards
• MILS
![Page 18: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/18.jpg)
Soft collar
• Allows 96% of flexion, 73% of extension
![Page 19: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/19.jpg)
Hard collar
• Allows 72-73% of normal flexion and extension
![Page 20: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/20.jpg)
Short boards
• Reduce movement in all planes
• Good results if combined with hard collar in prehospital settings
![Page 21: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/21.jpg)
MILS
![Page 22: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/22.jpg)
Method C-spine
motion
Intubation
difficulty
Time
required
Rigid collar 0 -
MILS 0-
Axial
traction
- -
![Page 23: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/23.jpg)
Radiological assessment
• Normal C-spine anatomy
• Choice
– Lateral, AP, open mouth- C-spine X-rays
– Combined plain film + CT 99% to 100%
sensitivity
– MRI very sensitive for soft tissue and
spinal cord
![Page 24: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/24.jpg)
Normal lateral C-spine
![Page 25: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/25.jpg)
Alignment
![Page 26: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/26.jpg)
![Page 27: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/27.jpg)
Predental space
![Page 28: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/28.jpg)
Prevertebral soft tissue
![Page 29: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/29.jpg)
![Page 30: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/30.jpg)
AP view
![Page 31: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/31.jpg)
![Page 32: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/32.jpg)
Odontoid view
![Page 33: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/33.jpg)
![Page 34: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/34.jpg)
SUMMARY
• Adequacy- C1 to T1 visible
• Pseudosubluxation?
• Look for any widening of spaces and indices
• Spinal cord injury without radiographic abnormality: “SCIWORA”
![Page 35: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/35.jpg)
Airway management
• Indication for securing airway– ? Apnoea– ? GCS <9/sustained seizure activity– ? Unstable midface trauma– ? Airway injuries– ? Large flail segment or respiratory failure– ? High aspiration risk– ? Inability to otherwise maintain an airway or
oxygenation
![Page 36: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/36.jpg)
![Page 37: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/37.jpg)
Clinical Predictors of Difficult Airway
![Page 38: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/38.jpg)
Airway management (contd…)
• Goal: Tracheal intubation without
causing further injury to spinal cord
• Method depends on
– Patient’s condition
– Level of cooperation
– Skill of anaesthesiologist
![Page 39: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/39.jpg)
Airway management (contd…)
•Effect of immobilization
technique on DL
–“We cannot stabilize the neck
without impairing the laryngeal
view”
![Page 40: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/40.jpg)
ASA (2003) algorithm for C-spine injury
![Page 41: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/41.jpg)
Failed intubation:Alternative techniques
• LMA
• Combitube
• Cricothyroidectomy
![Page 42: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/42.jpg)
FOB
• Technique of choice in awake cooperative patient
• Some authors recommend FOB even as initial intubation choice with 100% success rate.
• Some emphasize its limitations -technical difficulty -success rate only 73% in
ED.• Bullard laryngosope vs FOB
![Page 43: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/43.jpg)
Airway management techniques and their effect on C-spine
![Page 44: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/44.jpg)
Acute phase (4-6 weeks)
• Spinal shock
• Flaccid paralysis of muscles
• Loss of sympathetic tone
• Hypo reflexia
• Urinary retention
![Page 45: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/45.jpg)
Acute phase (4-6 weeks)
Management
• Treat associated life threatening conditions– Tension pneumothorax– Chest / pelvic/ orthopedic injuries
• Treatment of hypotension
• Pharmacological neuroprotection
![Page 46: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/46.jpg)
Steroids
• Suspected/ known blunt injury of spinal cord
• Methyl prednisolone.• Dose: 30mg/kg over 15 min followed by
infusion of 5.4mg/kg/hr for 24 – 48 hrs.• Started within 8 hrs of injury.• Contra indications: -penetrating injury -cauda equina syndrome
![Page 47: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/47.jpg)
Patient coming in chronic phase
• After recovery from spinal shock• Concerns
– Autonomic hyperreflexia– Supersensitivity of cholinergic receptors
• Autonomic hyper-reflexia– Chronic spinal cord lesion above T6– 85% of patients have this at some time during
the course of living– Uncontrolled reflex arc below the level of lesion
![Page 48: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/48.jpg)
Supersensitivity
• Denervation• Cholinergic receptor proliferation beyond the
motor end plate• Muscle contracts for a minimal Ach (10-4 to 10-5)• K+ released suddenly along entire length of
muscle fibre• Sch
– 4 to 10 meq/L increase in K+– Duration of supersensitivity: From 1 week upto 6
months to 2 years
• So Sch is safe in the first days of paraplegia, avoid it after 3rd or 4th day
![Page 49: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/49.jpg)
References
1. Rogers LF. Fractures and dislocations of the spine. In: Garfin’s Spine Trauma? Jefferson’s Series, 2006.
2. Jefferson G. Discussion on spinal injuries. Proc R Soc Med 1927;21:625–628.
3. Lali HS, Sehko MB, Fehlings MG. Epidemiology, demographics,and pathophysiology of acute spinal cord injury.Spine 2001; 26:S2–S12.
![Page 50: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/50.jpg)
4. Vale, FL, Burns J, Jackson AB, et al. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess merits of aggressive medical resusitation and blood pressure measurement. J Neurosurg1997; 87:239–246.
5.Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343:94–99[Erratum, N Engl J Med 2001; 344:464]
![Page 51: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/51.jpg)
6. A.U.Ghafoor et al,Caring for the patients with cervical spine injuries: what we have learned? Jounal of clin anesthesia (2005) 17 , 640-649.
7. Grande CM, Stene JK. Anesthesia for trauma. In: Miller RD, ed.Anesthesia. Philadelphia, Churchill Livingstone. 1994:2164.
8. Wilson WC. Trauma: airway management. ASA Difficult Airway Algorithm Modified for Trauma—and Five Common Trauma Intubation Scenarios. ASA Newsletter 2005; 69(11):10.
![Page 52: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/52.jpg)
9. ASA Task Force: Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology. 2003; 98(5):1269–1277.
10. Segal JL, Brunnemann SR.Clinical pharmacokinetics in patients with spinal cord injuries.Clin pharmacokinet: 17:109-29. 1989
11. Konishi A, Sakai T, Nishiyama T etal.Cervical spine movement during orotracheal intubation using McCoy laryngoscope compared with the Macintosh and Miller Laryngoscope.Masui 46:124-7, 1997.
![Page 53: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/53.jpg)
12. Hasting RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology 80:825-831, 1994.
13. Fitzgerald RD etal.Excursion of the cervical spine during tracheal intubation: blind oral intubation compared with direct laryngoscopy.Anesthesia 49:111-115,1994
14.Cohn AI, Zornow MH: Awake endotracheal intubation in patients with cervical spine disease: a comparison of the Bullard laryngoscope and fiberoptic bronchoscope.Anesth Analg 81:1283-1286, 1995.
![Page 54: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/54.jpg)
15. Crosby Et, Lui A: The adult cervical Spine: implication for airway management.Can J Anaesth 37:77-93, 1990.
16. Saha AK et al: Comarision of awake endotracheal intubation in patients with cervical spine disease: The lighted intubating stylet vs.Fibreoptic bronchoscope.Anesth Analg 87:477-479,1998.
17. Hastings RH et al.Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscope. Anesthesiology 82:859-869, 1995.
![Page 55: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/55.jpg)
18.Wangeman BU, Jantzen JP. Fibreoptic intubation of neurosurgical patients. Neurochirurgia (Stuttg)
1993;36:117-22.19.Ovassapian A, Dykes M. The role of fibreoptic
endoscopy in airway management. Semin Anesth
1987;6:93-104.20.Mlinek EJ et al. Fiberoptic intubation in
emergency department. Ann Emerg Med 1990;19:359-62.
![Page 56: SPINAL CORD INJURIES SURGERY ON THE CERVICAL SPINE Dr. Umakanth Dr. Prabhu Moderator : Prof. Rajeshwari.](https://reader036.fdocuments.in/reader036/viewer/2022081516/56649c8a5503460f9494409e/html5/thumbnails/56.jpg)
21. Afialo M et al. Fiberoptic intubation in the emergency department: A case series. J Emerg Med 1993;11:387-91.