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Anterior cervical discectomy entails a small but finite risk of cerebral ischemia related to carotid compression. refl.in/57

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May 18, 2011
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Cervical sympathetic chain might be injured, causing horner's syndrome with a dilated pupil. refl.in/58

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Feb 03, 2012
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Assess neck stability, & range of motion that elicits neurological symptoms (Risk of difficulty laryngoscopy & optimal intraop positioning)

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Dec 01, 2011
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Document any pre-existing neurology

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May 18, 2011
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Consider an arterial line to monitor for haemodynamic instability from vagal nerve and carotid body stimulation.

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Dec 07, 2011
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Avoid coughing which would risk disruption of surgical field. Ensure adequate muscle relaxation and analgesia.

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May 18, 2011
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If spinal chord oedema is present the surgeon may ask for a dose of dexamethasone to minimise oedema.

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Mar 16, 2012
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Consider awake fibreoptic intubation if cervical spine instabillity, or if poor neck mobility suggests risk of difficult laryngoscopy

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May 18, 2011
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Remote airway. Secure endotracheal tube well.

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May 18, 2011
Reinforced ETT coming out contralateral side of mouth
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Most surgeons approach from the right. Place endotracheal tube on the left side of the mouth and drape down to the left.

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Dec 04, 2011
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Spray vocal cords and trachea with local anesthetic to minimise coughing at emergence

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Dec 01, 2011
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Locate temporal artery prior to draping. After retracting the carotid, the surgeon might ask you to palpate the temporal artery

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Mar 16, 2012
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Slight reverse trendelenberg may reduce venous pressure and bleeding. refl.in/58

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May 18, 2011
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Supine position with neck extended on shoulder roll.

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May 18, 2011
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Bone graft may be taken from pelvis. Will require additional analgesia if this is the case.

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Dec 12, 2011
Although we haven't been using bone graft in our procedures here at monash for several years due to changes in surgical cages.
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Consider a postoperative PCA in patients undergoing multi-level procedures

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If SSEPs to be used, use 0.5MAC volatile supplemented with propofol infusion. #ref

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Mar 16, 2012
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Be alert for significant hemodynamic instability during retraction at the carotid artery.

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Sep 14, 2011
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Blood loss usually minimal, but risk of haemorrhage from carotid and jugular veins.

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May 18, 2011
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In prolonged cases it may be worthwhile confirming absence of upper airway edema due to venous congestion prior to extubation.

Use bronchoscope if open, or confirm pt can breath around ETT with cuff deflated

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Blocking ETT cuff may make the patient cough. Consider deflating cuff & checking for leak on PPV prior to full reversal
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Risk of recurrent laryngeal nerve injury resulting vocal cord paralysis and hoarse voice refl.in/58

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May 18, 2011
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Wake and assess neurology at end of case (even if patient is to remain intubated)

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