If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
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E-letters: Electronic letters published:
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Reduction in mouth opening with the philadelphia cervical collar
- Jameel Khan (2 November 2005)
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Endotracheal intubation with cervical collars
- Pervez Sultan (27 September 2005)
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Jameel Khan, SHO Anaesthetics Russells Hall Hospital, Dudley, UK
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Editor-Drs Goutcher and Lochhead have rightly pointed out the difficulty in mouth opening with the semi-rigid collar which could lead to difficulty in intubation. We faced a similar problem in our study wherein we compared the ease of intubation with the intubating laryngeal mask airway (ILMA)with direct laryngoscopy in simulated cervical spine injury using the philadelphia cervical collar. 50 ASA I or II patients without any clinical evidence of difficult airway were enrolled . We found that 14 patients had successful intubation in the first attempt (6 in ILMA & 8 in direct groups), 11 patients were successfully intubated in the second attempt (4 in the ILMA & 7 in the direct ). And 25 patients had to be intubated with manual in line stabilization and the anterior collar removed(15 in the ILMA & 10 in the direct). The application of the philadelphia cervical collar significantly reduced the mouth opening. And in order to avoid any problems,intubation for emergency trauma involves manual inline immobilisation of the cervical spine with removal of the anterior part of the cervical collar and proceeding with a rapid sequence induction (1). 1 Criswell JC, Parr MJ, Nolan JP. Emergency airway management in patients with cervical spine injuries, Anaesthesia 1994;49:900-3. Conflict of Interest:None declared |
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Pervez Sultan, Anaesthetics QMH Dunfermline
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Editor- The article published in Volume 95 Number 3 September 2005 looking at reduction in mouth opening in patients with semi-rigid cervical collars seems rather academic since the anterior part of the collar should be removed before attempting intubation (as recommended by the authors). Thus mouth opening is not affected by cervical collars during tracheal intubation attempts in trauma scenarios because no part of the collar should restrict movement of the mandible. The main danger of intubating with the whole collar in place is the aggravation of an existing C1-C2 injury when using the collar as a fulcrum during laryngoscopy. The recommended rapid sequence induction for severe trauma includes preoxygenation, manual inline immobilisation of the cervical spine with removal of the anterior part of the cervical collar, cricoid pressure, induction drugs, a neuromuscular blocker and direct laryngoscopy without extension of the atlanto-occipital joint (Ref 1). References 1.Criswell JC, Parr MJ, Nolan JP. Emergency airway management in patients with cervical spine injuries, Anaesthesia 1994;49:900-3. Conflict of Interest:None declared |
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