Anesthetic Management of Unstable Cervical Spine: Is Intubating LMA CTrach a Right Choice? A Case Report

The LMA (Laryngeal Mask Airway) CTrach (LMA North America Inc) is widely used for airway management in patients undergoing cervical spine immobilization. Three important concerns in these patients are stabilization of the neck, prevention of aspiration of regurgitated gastric contents, and hypoxia. The standard maneuver—down-up down maneuver—applied to the LMA CTrach to improve the glottis view has been reported to cause pulmonary aspiration in cases of regurgitation of gastric contents in predisposed patients. In the present case report, the LMA CTrach was used to facilitate endotracheal intubation in an anesthetized and paralyzed patient. We hypothesize that the factors responsible for the increased risk of pulmonary aspiration with the use of an LMA CTrach in patients with cervical spine trauma are its use in anesthetized patients, use of optimization maneuvers (down-up down maneuver) leading to an unprotected airway, and the underlying risk of regurgitation due to autonomic nervous system dysfunction. We thus advocate the routine use of aspiration prophylaxis and the use of an awake technique whenever the LMA CTrach is used for airway management in patients with cervical spine injuries, to reduce the risk of aspiration.