[Respiratory failure from upper airway collapse following anterior cervical spine surgery]

To determine the frequencies of variables that might predispose to upper airway collapse in a series of patients undergoing anterior cervical spine surgery.

Retrospective review of the medical records of 204 patients who underwent anterior cervical spine neurosurgery between 2003 and 2009. We gathered information on perioperative variables that might be related to upper airway collapse, on whether intensive care unit admission was planned or not, and on the moment when obstruction developed.

Partial obstruction occurred in 7 cases (3.4%); 4 (1.9%) resolved with tracheal intubation and 3 (1.5%) required emergency tracheostomy. None of the variables were significantly associated with the development of postoperative upper airway obstruction in these patients.

Upper airway obstruction after anterior cervical spine surgery is an unforeseen event and the emergency assessment of the airway may not coincide with the assessment of the anesthetist during the preanesthetic visit. This event may constitute an emergency for which preparation times and resources may differ from those available when this complication is foreseen. The problem for the anesthetist is not the impossibility of tracheal intubation but rather the difficulty of ventilating through a facial mask or supraglottic device, possibly with life-threatening consequences.