AIRWAY MANAGEMENT IN PATIENT WITH CERVICAL SPINE INJURY WITH GARDNER- WELLS TONGS IN-SITU FOR CERVICAL TRACTION POSTED FOR ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF) - A CASE SERIES
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Abstract
Airway management in patients with cervical spine injuries poses significant challenges, particularly when cervical stabilization is maintained using Gardner-Wells tongs. These devices provide axial skeletal traction to align and immobilize the cervical spine, minimizing the risk of further spinal cord injury in unstable cervical pathologies [1]. However, such immobilization severely restricts cervical mobility and engages head end of the patient complicating tracheal intubation and increasing the risk of neurologic deterioration during airway manipulation [2,3].
The primary objective in such cases is to preserve spinal cord integrity through manual inline stabilization (MILS), while ensuring a secure and effective airway. Fibreoptic/ambuscope intubation is frequently considered the gold standard in these scenarios due to minimal cervical movement [4,5].
We present a case series of six patients with cervical spine injuries requiring anterior cervical discectomy and fusion (ACDF) who were immobilized with Gardner-Wells tongs at the time of surgery. All patients underwent successful endotracheal intubation using a flexible fibreoptic/ ambuscope scope introduced from the right lateral side. Prior to intubation, the anterior cervical collar was removed and the cervical spine was manually stabilized using MILS from torso side. No neurologic deterioration or airway complications were observed perioperatively.
This series supports the feasibility and safety of lateral fibreoptic/ambuscope intubation in patients with rigid cervical traction using Gardner-Wells tongs, provided that meticulous technique and manual stabilization are employed. These findings highlight the importance of multidisciplinary coordination between anesthesiologists and spine surgeons in managing high-risk cervical spine cases.
References
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3. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force. Anesthesiology. 2013;118(2):251– 70.
4. Rosenblatt WH, Sukhupragarn W. Airway management in the patient with cervical spine instability. In: Hagberg CA, editor. Benumof and Hagberg’s Airway Management. 3rd ed. Philadelphia: Elsevier; 2013. p. 703–17.
5. Wang HE, Sweeney TA, O'Connor RE. Out-of-hospital endotracheal intubation and neuromuscular blocking agents. Ann Emerg Med. 2001;38(5):617–24.
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Dr Supriya Kar
Assistant professor, Department of Anesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha
Dr Ankita Das
Assistant professor, KIIT University
Dr Sapna Das
Assistant Professor, Department of Anesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar