Anterior cervical spine surgery

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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

Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System Considerations
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.
Respiratory Limited neck ROM related to pain or structural changes can cause difficult laryngoscopy. Recurrent laryngeal nerve potentially at risk of damage intraop.

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management


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.


Postoperative management


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
Surgical time
Postoperative disposition
Pain management
Potential complications