Influence of intubation and positioning on the appearance of joint blockage in the area of the cervical spine in patients with neuromuscular blockade

• Published in: Manuelle Medizin 1999-06, Vol.37 (3), p.137-142
• Main Authors: Goldmann, R, Kriebel-Goldmann, C, Leuwer, M, Piepenbrock, S
• Format: Article
• Language: English
• Subjects: Intubation; Patients
• ISSN: 0025-2514; 1433-0466
• DOI: 10.1007/s003370050120

SummaryPatients who have to undergo anesthesia with intubation and neuromuscular relaxation often complain of pain in the neck, resulting from joint blockage of the cervical spine. Often the intubation is held to be responsible for this fact, although this assumption has not really been examined. Earlier studies have show that intraoperative manipulation and movement of the patient like making the patient lie down under neuromuscular blocking or an extreme posture could be of greater influence than intubation for the occurrence of joint blockage.To shed light on the influence of intubation for the appearance of joint blockage we examined 90 patients in three groups who had to undergo anesthesia with intubation and neuromuscular relaxation. In their history, all patients had inconspicious cervical spinal columns.One group underwent surgery lying normally on their backs; the second group had to be turned on their side or abdomen after anesthesia was induced; the third group had to lie with the head extremely back. The cervical spine of the patients was examined before intubation, directly after intubation, before lying down and soon after finishing the anesthesia. All patients were intubated in the improved Jackson position and using a Macintosh laryngoscope.After intubation only 4 to 90 patients had disturbances in this region; postoperatively there were 2, 16, and 29 patients in the three blockage groups, respectively. The total number of blockages in the three groups were postoperatively 5, 23, and 50 versus 2, 3 and 4 after intubation. This difference is significant (P < 0.01). Regarding only the head joints the differences are also significant (P < 0.05 with 2, 3 and 4 versus 4, 13 and 39 blockages.We conclude that normal intubation of patients lying on their back in the improved Jackson position is of much less influence on the appearance of cervical joints blockage than intraoperative manipulations or extreme positioning of the patients' heads, as they have no muscular protection because of muscle relaxation.