الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In anaesthesia, intubation is an essential artistry for an anaesthetist during airway management. Anaesthetists are responsible for the management of the airway in patients with unstable cervical spine (C spine). Tracheal intubation must be performed with utmost care in patients with suspected C spine pathology. The optimal tracheal intubation technique for patients with potential C spine injury remains controversial.
Awake fiberoptic intubation has long been considered as the “gold standard” in management of patients with suspected C spine injury with C immobilization. Despite it may expose C spine to the least traction, it may be technically difficult in certain patients, and its potential may be limited by lack of expertise, blood or secretions in the airway, lack of cooperation in awake patients, and the additional time required to prepare for and execute the procedure. Interestingly, there is no scientific evidence supporting better clinical outcomes in patients with C spine disease who were intubated with FIS compared with other commonly used airway devices.(16)
Direct laryngoscopy with manual in-line stabilization by an assistant in the anesthetized patient is most commonly used. It is considered by many a standard of care, as it is quicker, less affected by blood, secretions, and vomitus present in the airway and does not require patient cooperation. Cervical immobilization by MILS or collar might protect the C spine but it significantly limits cervical extension to a degree that makes intubation difficult, lengthening the duration of intubation or causing repeated intubation interventions.