- Email: [email protected]
Anaesthesia for spinal surgery in adults
Correspondence
6 Scott DHT. Editorial II. ‘In the country of the blind, the one-eyed man is king’. Br J Anaesth 1999; 82: 820–1 7 Mallinson C, Bennett J, Hodgson P, Petros AJ. Position of the internal jugular vein in children. A study of the anatomy using ultrasonography. Paediatr Anaesth 1999; 9: 111–14 doi:10.1093/bja/aei501
Anaesthesia for spinal surgery in adults
E. Cardan* P. J. Appleton Southampton, UK *E-mail: [email protected]
D. Raw Liverpool, UK E-mail: [email protected]
1 Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth 2003; 91: 886–904 doi:10.1093/bja/aei502
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Downloaded from http://bja.oxfordjournals.org/ at Rice University on March 13, 2015
Editor—We read with interest the comprehensive review by Raw, Beattie and Hunter on anaesthesia for spinal surgery in adults.1 We question the use of reinforced endotracheal tubes for operations on the cervical spine. Whilst appreciating the risks of airway obstruction during operations on the cervical spine, we wish to point out that, with the obligatory use of x-ray screening for medico-legal purposes to confirm levels during spinal surgery, the presence of a reinforced endotracheal tube could interfere with radiological images. There is, in this context, a particular surgical setting where a full transparent tube has to be definitely favoured, that of the internal fixation of the odontoid peg with anterior cervical approach. With modern disposable transparent endotracheal tubes, we believe the dangers of x-ray misdiagnosis far outweigh the problem of airway obstruction.
Editor—Thank you for the opportunity to reply to Drs Cardan and Appleton. The presence of a reinforced endotracheal tube can interfere with radiological imaging of the cervical spine. However, for many cervical spine procedures, lateral images are sufficient to confirm levels and the presence of a reinforced endotracheal tube should not impair the quality of these images. In the case of surgery for internal fixation of the odontoid peg, AP screening is required. However, it is possible to place a reinforced endotracheal tube and to manipulate it to the left or right to obtain satisfactory radiological images. It is more difficult to manipulate a nasotracheal tube and, if this route is used, a radiolucent tube is to be preferred. Our review1 stated ‘for anterior (cervical) surgery, a reinforced tracheal tube will reduce the risk of airway obstruction as tracheal retraction occurs’. The potential for airway obstruction will be different for different surgical approaches and different surgical teams, and Drs Cardan and Appleton make an important point that the risk of airway obstruction should always be weighed against the possibility of inadequate radiological imaging.
6 Scott DHT. Editorial II. ‘In the country of the blind, the one-eyed man is king’. Br J Anaesth 1999; 82: 820–1 7 Mallinson C, Bennett J, Hodgson P, Petros AJ. Position of the internal jugular vein in children. A study of the anatomy using ultrasonography. Paediatr Anaesth 1999; 9: 111–14 doi:10.1093/bja/aei501
Anaesthesia for spinal surgery in adults
E. Cardan* P. J. Appleton Southampton, UK *E-mail: [email protected]
D. Raw Liverpool, UK E-mail: [email protected]
1 Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth 2003; 91: 886–904 doi:10.1093/bja/aei502
137
Downloaded from http://bja.oxfordjournals.org/ at Rice University on March 13, 2015
Editor—We read with interest the comprehensive review by Raw, Beattie and Hunter on anaesthesia for spinal surgery in adults.1 We question the use of reinforced endotracheal tubes for operations on the cervical spine. Whilst appreciating the risks of airway obstruction during operations on the cervical spine, we wish to point out that, with the obligatory use of x-ray screening for medico-legal purposes to confirm levels during spinal surgery, the presence of a reinforced endotracheal tube could interfere with radiological images. There is, in this context, a particular surgical setting where a full transparent tube has to be definitely favoured, that of the internal fixation of the odontoid peg with anterior cervical approach. With modern disposable transparent endotracheal tubes, we believe the dangers of x-ray misdiagnosis far outweigh the problem of airway obstruction.
Editor—Thank you for the opportunity to reply to Drs Cardan and Appleton. The presence of a reinforced endotracheal tube can interfere with radiological imaging of the cervical spine. However, for many cervical spine procedures, lateral images are sufficient to confirm levels and the presence of a reinforced endotracheal tube should not impair the quality of these images. In the case of surgery for internal fixation of the odontoid peg, AP screening is required. However, it is possible to place a reinforced endotracheal tube and to manipulate it to the left or right to obtain satisfactory radiological images. It is more difficult to manipulate a nasotracheal tube and, if this route is used, a radiolucent tube is to be preferred. Our review1 stated ‘for anterior (cervical) surgery, a reinforced tracheal tube will reduce the risk of airway obstruction as tracheal retraction occurs’. The potential for airway obstruction will be different for different surgical approaches and different surgical teams, and Drs Cardan and Appleton make an important point that the risk of airway obstruction should always be weighed against the possibility of inadequate radiological imaging.