Display options
Cite
Debkowska MP, Butterworth JF, Moore JE, et al. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. J Spine Surg. 2019;5(1):142-154doi: 10.21037/jss.2019.03.01.
Debkowska, M. P., Butterworth, J. F., Moore, J. E., Kang, S., Appelbaum, E. N., & Zuelzer, W. A. (2019). Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. Journal of spine surgery (Hong Kong), 5(1), 142-154. https://doi.org/10.21037/jss.2019.03.01
Debkowska, Monika P, et al. "Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy." Journal of spine surgery (Hong Kong) vol. 5,1 (2019): 142-154. doi: https://doi.org/10.21037/jss.2019.03.01
Debkowska MP, Butterworth JF, Moore JE, Kang S, Appelbaum EN, Zuelzer WA. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. J Spine Surg. 2019 Mar;5(1):142-154. doi: 10.21037/jss.2019.03.01. PMID: 31032449; PMCID: PMC6465475.
Copy Download .nbib Format: NLM
Share it on

J Spine Surg. 2019 Mar;5(1):142-154. doi: 10.21037/jss.2019.03.01.

Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy.

Journal of spine surgery (Hong Kong)

Monika P Debkowska, John F Butterworth, Jaime E Moore, Soobin Kang, Eric N Appelbaum, Wilhelm A Zuelzer

Affiliations

  1. Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
  2. Department of Anesthesiology, Virginia Commonwealth University Health, Richmond, VA, USA.
  3. Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
  4. Department of Radiology, Virginia Commonwealth University Health, Richmond, VA, USA.

PMID: 31032449 PMCID: PMC6465475 DOI: 10.21037/jss.2019.03.01

Abstract

Anterior cervical spine surgery (ACSS) is a common procedure, but not without its own risks and complications. Complications that can cause airway compromise occur infrequently, but can rapidly lead to respiratory arrest, leading to severe morbidity or death. Knowing emergent post-operative airway management including surgical airway placement is critical. We aim to review the different etiologies of post-operative airway compromise following ACSS, the predictable timeline in which they occur, and the most appropriate treatment and management for each. We place special emphasis on the timing and proper surgical technique for an emergent cricothyrotomy. Angioedema is seen the earliest as a cause of post-operative airway compromise, typically within 6-12 hours. Retropharyngeal hematomas can be seen between 6-24 hours, most commonly within 12 hours. Pharyngolaryngeal edema is seen within 24-72 hours. After 72 hours, retropharyngeal abscess is the most likely etiology. Several studies have utilized delayed extubation protocols following ACSS based on patient risk factors and found reduced postoperative airway complications and reintubation rates. The administration of perioperative corticosteroids continues to be controversial with high-level studies recommending both for and against their use. Animal studies showed that after cardiac arrest, the brain can recover if oxygenation is restored within 5 minutes, but this time is likely shorter with asphyxia prior to cardiac arrest. Experience and training are essential to reduce the time for successful cricothyrotomy placement. Physicians must be prepared to diagnose and treat acute postoperative airway complications following ACSS to prevent anoxic brain injury or death. If emergent intubation cannot be accomplished on the first attempt, physicians should not delay placement of a surgical airway such as cricothyrotomy.

Keywords: Anterior cervical spine surgery (ACSS); cricothyrotomy; pharyngolaryngeal edema; post-operative airway compromise; resuscitation; retropharyngeal hematoma

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

  1. Am J Emerg Med. 1999 May;17(3):308-9 - PubMed
  2. Skeletal Radiol. 1999 Aug;28(8):444-6 - PubMed
  3. J Neurosurg. 2001 Apr;94(2 Suppl):185-8 - PubMed
  4. Spine (Phila Pa 1976). 2002 May 1;27(9):949-53 - PubMed
  5. JAMA. 2002 Dec 18;288(23):3035-8 - PubMed
  6. Eur Spine J. 2003 Feb;12(1):84-90 - PubMed
  7. Anaesthesist. 2003 Apr;52(4):304-10 - PubMed
  8. J Bone Joint Surg Am. 1958 Jun;40-A(3):607-24 - PubMed
  9. J Bone Joint Surg Am. 2004 Feb;86-A(2):370-2 - PubMed
  10. J Neurosurg Anesthesiol. 1992 Jul;4(3):199-202 - PubMed
  11. Int Orthop. 2006 Aug;30(4):290-4 - PubMed
  12. J Spinal Disord Tech. 2006 Aug;19(6):389-93 - PubMed
  13. Lancet. 2007 Mar 31;369(9567):1083-9 - PubMed
  14. Spine (Phila Pa 1976). 2007 Oct 1;32(21):2310-7 - PubMed
  15. Acta Neurochir (Wien). 2008 Feb;150(2):111-8; discussion 118 - PubMed
  16. J Neurosurg Anesthesiol. 2008 Jan;20(1):69-70 - PubMed
  17. Crit Care. 2008;12(5):R115 - PubMed
  18. Neurosurgery. 2008 Oct;63(4 Suppl 2):295-301; discussion 301-2 - PubMed
  19. J Am Acad Orthop Surg. 2008 Dec;16(12):729-38 - PubMed
  20. Spine (Phila Pa 1976). 2009 Feb 1;34(3):229-32 - PubMed
  21. J Bone Joint Surg Am. 1991 Apr;73(4):544-51 - PubMed
  22. Spine (Phila Pa 1976). 2010 Jul 1;35(15):E739-42 - PubMed
  23. Spine (Phila Pa 1976). 2011 Dec 15;36(26):2286-92 - PubMed
  24. Clin Orthop Surg. 2012 Mar;4(1):77-82 - PubMed
  25. Open Orthop J. 2012;6:108-13 - PubMed
  26. AJR Am J Roentgenol. 2012 Jul;199(1):W123-9 - PubMed
  27. J Forensic Sci. 2013 Jan;58 Suppl 1:S264-6 - PubMed
  28. J Clin Anesth. 2013 Feb;25(1):66-72 - PubMed
  29. Spine (Phila Pa 1976). 2014 Jan 15;39(2):134-9 - PubMed
  30. Spine (Phila Pa 1976). 2014 Feb 15;39(4):E246-52 - PubMed
  31. Curr Opin Crit Care. 2014 Jun;20(3):266-72 - PubMed
  32. Spine (Phila Pa 1976). 2014 Aug 15;39(18):1506-12 - PubMed
  33. Spine J. 2014 Dec 1;14(12):2954-8 - PubMed
  34. Spine (Phila Pa 1976). 2014 Dec 1;39(25):2062-9 - PubMed
  35. J Neurosurg Spine. 2015 Aug;23(2):137-43 - PubMed
  36. Am J Emerg Med. 2015 Sep;33(9):1297-304 - PubMed
  37. Asian J Neurosurg. 2015 Jul-Sep;10(3):253-5 - PubMed
  38. Acta Neurochir (Wien). 1989;99(1-2):41-50 - PubMed
  39. Spine (Phila Pa 1976). 2017 Mar 15;42(6):379-384 - PubMed
  40. J Orthop Surg Res. 2017 Jan 26;12(1):19 - PubMed
  41. Int J Surg. 2017 May;41:28-33 - PubMed
  42. Global Spine J. 2017 Apr;7(1 Suppl):96S-102S - PubMed
  43. Neurocrit Care. 2018 Apr;28(2):247-256 - PubMed
  44. Spine (Phila Pa 1976). 2017 Sep 15;42(18):E1058-E1066 - PubMed
  45. Simul Healthc. 2017 Apr;12(2):76-82 - PubMed
  46. J Spine Surg. 2017 Sep;3(3):444-459 - PubMed
  47. Spine (Phila Pa 1976). 2018 Aug 1;43(15):1025-1030 - PubMed
  48. Global Spine J. 2018 May;8(3):286-302 - PubMed
  49. Laryngoscope. 1987 Sep;97(9):1094-8 - PubMed
  50. Am J Emerg Med. 1993 May;11(3):207-9 - PubMed
  51. J Neurosurg. 1997 Feb;86(2):297-302 - PubMed
  52. J Neurosurg. 1997 Jun;86(6):990-7 - PubMed
  53. Neurol Neurochir Pol. 1997 Jan-Feb;31(1):135-44 - PubMed
  54. Resuscitation. 1997 Aug;35(1):41-52 - PubMed
  55. AJR Am J Roentgenol. 1997 Sep;169(3):869-74 - PubMed
  56. Spine (Phila Pa 1976). 1997 Sep 15;22(18):2188-90 - PubMed
  57. Anaesth Intensive Care. 1998 Jun;26(3):305-7 - PubMed

Publication Types