The safety of awake tracheal intubation in cervical spine injury

Can J Anaesth. 1992 Feb;39(2):114-7. doi: 10.1007/BF03008639.


As a referral centre for cervical spine injuries, we have routinely performed awake tracheal intubation when intubation was indicated. A retrospective case control study was undertaken to review the frequency of neurological deterioration and aspiration associated with our approach. Neurological deterioration was assessed by a change in level of injury or neurological grade at admission and discharge. Four hundred and fifty-four patients with critical cervical spine and/or cord injuries were reviewed over an eight-year period. A case group of 165 patients underwent tracheal intubation awake within two months of injury. A control group of 289 remained unintubated during the same period. A comparison of spinal neurological status between admission and discharge revealed no statistically significant difference in neurological deterioration between the two groups. This occurred despite a greater injury severity score in the case group. No evidence of aspiration during intubation was documented. We conclude that awake tracheal intubation is a safe method of airway management in patients with cervical spine injuries.

MeSH terms

  • Adult
  • Case-Control Studies
  • Cervical Vertebrae / injuries*
  • Consciousness
  • Humans
  • Immobilization
  • Injury Severity Score
  • Intubation, Intratracheal* / adverse effects
  • Intubation, Intratracheal* / methods
  • Neurologic Examination
  • Retrospective Studies
  • Sensation / physiology
  • Spinal Cord Injuries / physiopathology
  • Spinal Cord Injuries / therapy*
  • Spinal Fractures / physiopathology
  • Spinal Fractures / therapy*
  • Time Factors
  • Traction