Anterior cervical spine surgery

Anterior cervical spine surgery

Anesthesia type	General
Airway	ETT
Lines and access	PIV, possible arterial line
Monitors	Standard, possible invasive BP monitoring, possible neuromonitoring
Primary anesthetic considerations
Preoperative	Neck ROM, preoperative neurologic exam
Intraoperative	TIVA for neuromonitoring
Postoperative
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Preoperative management

Patient evaluation

System	Considerations
Airway	Potentially limited neck ROM related to pain, trauma, or mechanical stabilization devices leading to more challenging airway. Potential unstable cervical spine, instrumentation could cause permanent paralysis. Consider awake intubation if high concern for unstable spine or difficult airway.
Neurologic	Possible preexisting motor and/or sensory deficits, particularly in the upper extremities. These symptoms may be exacerbated by head/neck positioning. May have chronic pain.
Cardiovascular	Intraoperative bradycardia related to traction on the carotid bulb.
Pulmonary	Limited neck ROM related to pain or structural changes can cause difficult laryngoscopy. Recurrent laryngeal nerve potentially at risk of damage intraop.
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Monitoring and access

Standard ASA monitors. Neuromonitoring per surgeon request. PIV 18-20g usually sufficient. Arterial line based on patient comorbidities.

Induction and airway management

Potentially limited neck ROM related to pain, trauma, or mechanical stabilization devices leading to more challenging airway. Potential unstable cervical spine, instrumentation could cause permanent paralysis. Consider awake intubation if high concern for unstable spine or difficult airway. Consider neuro exam following awake intubation if concern for cervical spine injury.

Positioning

Positioned supine, typically with shoulder roll for exposure and head on a doughnut gel pillow to facilitate neck positioning.

Maintenance and surgical considerations

• Neuromonitoring may be used to detect potential nerve/spinal cord injury. In these cases, surgical teams typically require no paralytic and frequently request TIVA techniques to minimize the affect of anesthetic on neuromonitoring.

Postoperative management

Disposition

Majority of patients appropriate for floor, some surgeons request ICU for monitoring.

Potential complications

• Neck hematoma
• Airway edema
• Injury to cranial nerves, recurrent laryngeal nerve, and/or superior laryngeal nerve
• Dural tear

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications