The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury.

BACKGROUND: The potential merits and dangers of orotracheal and nasotracheal intubation in patients with injury to the cervical spine or spinal cord continue to be debated. To address this issue, a prospective study was conducted at a level 1 trauma center in patients with respiratory embarrassment and either or both of these injuries. MATERIALS AND METHODS: Over a 7-year period, all such patients underwent neurologic examination by a trauma surgeon on arrival at the trauma center, immediately after endotracheal intubation, and at frequent intervals throughout hospitalization. Cervical immobilization was maintained manually during endotracheal intubation. When necessary, patients were sedated or paralyzed with short-acting pharmacologic agents. RESULTS: During the study period, there were 81 patients with 98 cervical vertebral body fractures, but without evidence of spinal cord injury on initial examination. Sixty-seven patients (83%) were legally intoxicated, and 12 patients had closed head injury. Endotracheal intubation was performed in 26 patients with unstable fractures, and 22 patients were intubated via the oral route. No patient manifested a subsequent neurologic deficit. Sixty-nine additional patients presented with high spinal cord injury; 16 had no cervical spine fracture, and 53 patients had 61 fractures of the cervical vertebrae. Sixty patients (87%) were intoxicated, and 8 patients had closed head injury. Endotracheal intubation was performed in 29 of these patients, and 26 patients were intubated via the oral route. No patient experienced further neurologic deficit following endotracheal intubation. CONCLUSION: In trauma victims with or at high risk of cervical spinal cord injury, orotracheal intubation is a rapid, safe means of achieving airway control.

Fate of autogenous fat implants in the frontal sinuses of cats.

Cats (n = 4) were subjected to a bilateral osteotomy overlying the frontal sinuses. The right sinus of each cat served as a control, and the left sinus was filled with autogenous fat harvested from the subcutaneous region of the ventral part of the abdomen. All 4 cats were euthanatized at 200 days. The experiment was designed to determine whether satisfactory obliteration of the left frontal sinus could be accomplished without the benefit of intraoperative magnification. Grossly, obliteration of all 4 sinuses was accomplished in 3 of 4 cats. Light microscopy revealed fluid and/or regrowth of mucous membrane, both considered to be unfavorable sequelae. Although some fat retained viability in the sinus (50% in one cat, 40% in another), most of the obliteration was from mixed fibrous-adipose tissue or bony ingrowth. The clinical significance of this study was not determined, since all 4 cats were free of sinusitis before adipose tissue implantation.