Articles   |    
Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis
I Wattenmaker; M Concepcion; P Hibberd; S Lipson
J Bone Joint Surg Am, 1994 Mar 01;76(3):360-365
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


We reviewed the records of 128 patients who had a total of 128 consecutive posterior operations on the cervical spine for problems related to rheumatoid arthritis. Our purpose was to examine perioperative complications related to the airway. The patients were divided into two groups for analysis on the basis of the technique of intubation that had been used. An upper-airway obstruction developed after extubation in eight (14 per cent) of the fifty-eight patients who had been intubated without fiberoptic assistance compared with one (1 per cent) of the seventy patients who had been intubated fiberoptically (p = 0.02). The two groups had similar characteristics with regard to age, sex, severity of the myelopathy, American Rheumatology Association classification, American Society of Anesthesiologists physical status classification, cigarette use, duration of the arthritis, use of preoperative traction, use of steroids (both preoperatively and intraoperatively), size of the endotracheal tube, duration of the operation, total duration of the anesthesia, intraoperative fluid balance, and type of immediate immobilization of the neck. The only significant difference between the groups was the time to extubation, which averaged 17.9 hours in the fiberoptic group and 10.6 hours in the non-fiberoptic group (p = 0.02). Logistic regression analysis showed that non-fiberoptic intubation was the significant risk factor, even when allowance was made for the difference in the lengths of time to extubation. We concluded that this life-threatening complication can be minimized with fiberoptic management of the airway.

Figures in this Article
    This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Oklahoma - The University of Oklahoma
    California - UCLA/OH Department of Orthopaedic Surgery
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina