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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Overview

Indications

Surgical procedure

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

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

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 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.

Emergence

Postoperative management

Disposition

Pain management

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

References