From the Guidelines
For patients with grade 1-2 cervical spine injury, I recommend using videolaryngoscopy for tracheal intubation, as it is associated with minimal cervical spine movement, according to the most recent guidelines from the Difficult Airway Society and other reputable organizations 1. This approach is supported by the latest evidence, which suggests that videolaryngoscopy is a safe and effective method for airway management in patients with suspected or confirmed cervical spine injury. Some key points to consider when managing the airway in these patients include:
- Minimizing cervical spine movement during pre-oxygenation and facemask ventilation 1
- Using jaw thrust instead of head tilt plus chin lift when a simple maneuver is required to maintain an airway 1
- Considering the use of second-generation supraglottic airway devices (SADs) over first-generation SADs 1
- Removing the anterior part of a semi-rigid or rigid cervical collar during tracheal intubation attempts to minimize cervical spine movement 1 It is essential to weigh the risks and benefits of different airway management strategies and to consider the individual patient's needs and circumstances. Regular training in the use of videolaryngoscopy with cervical spine immobilization is also crucial for clinicians who perform tracheal intubation in patients with suspected or confirmed cervical spine injury 1. By following these guidelines and using the most appropriate airway management techniques, clinicians can help minimize the risk of complications and improve patient outcomes. Multidisciplinary planning, preparation, and optimization of human factors are also essential before airway management in patients with suspected or confirmed cervical spine injury 1. Overall, the goal is to provide safe and effective airway management while minimizing the risk of cervical spine movement and potential neurological complications.
From the Research
Grade 1-2 Cervical Intraepithelial Neoplasia (CIN)
- CIN 1 and CIN 2 are precancerous lesions that can progress to high-grade lesions or cancer if left untreated 2, 3, 4
- Studies have shown that CIN 1 and CIN 2 can regress spontaneously, and the risk of progression to cancer is low 4, 5
- The management of CIN 1 and CIN 2 typically involves regular follow-up with cytology and colposcopy, rather than immediate treatment 3, 5
Treatment Options
- Loop electrosurgical excision procedure (LEEP) is a common treatment option for CIN 2-3, but it may not be necessary for all patients with CIN 1 or CIN 2 2, 3, 6
- A study found that approximately 25% of patients with CIN 2-3 in colposcopic directed biopsy specimens had CIN 1 or less found in LEEP specimens 6
- Predicting factors of having CIN 1 or less in LEEP specimens were nulliparity, low grade Pap results, and low grade colposcopic impression 6
Follow-up and Surveillance
- Post-treatment high-risk HPV testing can be used to detect residual or recurrent disease 2
- A study found that post-treatment Hybrid Capture II had an extremely high sensitivity for detecting recurrences 2
- Regular follow-up with cytology and colposcopy is recommended for patients with CIN 1 or CIN 2, but the optimal follow-up schedule is not well established 3, 4, 5