• H Claude Sagi, William Beutler, Eben Carroll, and Patrick J Connolly.
• University of California, San Francisco-Fresno Medical Education Program, Fresno, California, USA. eversosaggy@cs.com
• Spine. 2002 May 1;27(9):949-53.

Study DesignRetrospective chart review of 311 anterior cervical procedures.ObjectivesTo assess the incidence and variables that predispose to an airway complication in a large series of anterior cervical surgical procedures.Summary Of Background DataA rare but potentially lethal complication after anterior cervical spine surgery is respiratory compromise and airway obstruction. Some risk factors are thought to include two-level corpectomy in myelopathic patients with a history of heavy smoking and asthma. No previous study in the literature has been directed at examining the factors specifically related to airway complications after anterior cervical spine surgery.MethodsEach chart was examined for patient characteristics and pathology, anesthetic parameters and problems, operative procedure, and postoperative course and management. Statistical analysis was performed.ResultsNineteen patients (6.1%) had an airway complication and six (1.9%) required reintubation. One patient died. Symptoms developed on average 36 hours postoperatively. All complications except for two were attributable to pharyngeal edema. Variables that were found to be statistically associated with an airway complication (P < 0.05) were exposing more than three vertebral bodies, a blood loss >300 mL, exposures involving C2, C3, or C4, and an operative time >5 hours. A history of myelopathy, spinal cord injury, pulmonary problems, smoking, anesthetic risk factors, and the absence of a drain did not correlate with an airway complication.ConclusionsPatients with prolonged procedures (i.e., >5 hours) exposing more than three vertebral levels that include C2, C3, or C4 with more than 300-mL blood loss should be watched carefully for respiratory insufficiency.

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