Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
J Clin Rheumatol. 2012 Mar;18(2):61-6. doi: 10.1097/RHU.0b013e318247bb0d.
There is no consensus on the role of preoperative cervical spine radiographs to screen for instability in patients with rheumatoid arthritis (RA).
This study aimed to evaluate the preoperative use of cervical spine radiographs in patients with RA undergoing preoperative anesthesia assessment and to determine whether preoperative radiographic findings influenced anesthesia delivery techniques.
We reviewed all medical records of RA patients who underwent surgical procedures requiring general anesthesia with airway intubation or monitored anesthesia care without airway intubation. We examined cervical spine radiographs obtained up to 2 years before surgery and determined airway management techniques used during surgery.
Overall, 215 patients with RA underwent 217 individual surgeries requiring anesthesia; of these, 176 (82%) underwent general anesthesia with airway management with direct laryngoscopy in 83%, fiber-optic intubation in 10%, and laryngeal mask in 7%. Ninety-two (52%) of the patients receiving airway management had radiographs available for cervical spine evaluation; of these, only 7 (8%) had complete radiographic examinations with which to evaluate possible atlantoaxial subluxation. Eighteen (20%) of the 92 patients receiving airway management had radiographic evidence of cervical spine abnormality. Multiple regression models were conducted to evaluate the association of patient demographics and airway management technique used and showed that the use of fiber-optic intubation or laryngeal mask was not influenced by radiographic results. A difficult oropharyngeal class/glottic visualization grade (3 or 4) as determined by the anesthesiologist was the only statistically significant predictor of fiber-optic intubation or laryngeal mask use.
Cervical spine abnormalities were frequently noted in patients who underwent general surgery but did not influence the choice of airway management. Future prospective studies evaluating the utility of cervical spine radiographs in patients with RA and practice guidelines are needed to ensure appropriate and cost-effective perioperative cervical evaluation and management of patients with RA.
类风湿关节炎（RA）患者术前颈椎 X 线片是否用于筛查不稳定尚无共识。
本研究旨在评估 RA 患者术前颈椎 X 线片在术前麻醉评估中的应用，并确定术前影像学结果是否影响麻醉实施技术。
我们回顾了所有接受全身麻醉（气管插管或无气管插管的监测麻醉）行择期手术的 RA 患者的病历。我们检查了术前 2 年内获得的颈椎 X 线片，并确定了术中使用的气道管理技术。
共有 215 例 RA 患者接受了 217 例需要麻醉的手术；其中 176 例（82%）接受了全身麻醉，83%采用直接喉镜进行气道管理，10%采用纤维支气管镜，7%采用喉罩。92 例（52%）接受气道管理的患者有颈椎 X 线片可供评估；其中仅 7 例（8%）进行了完整的颈椎影像学检查以评估可能的寰枢关节半脱位。92 例接受气道管理的患者中有 18 例（20%）存在颈椎异常的影像学证据。采用多元回归模型评估患者人口统计学特征和气道管理技术的使用与纤维支气管镜或喉罩的相关性，结果显示，纤维支气管镜或喉罩的使用不受影像学结果的影响。麻醉师确定的困难口咽分级/声门可视度分级（3 级或 4 级）是唯一具有统计学意义的纤维支气管镜或喉罩使用的预测因素。
尽管接受普通外科手术的患者常存在颈椎异常，但这并未影响气道管理方式的选择。需要进一步前瞻性研究评估 RA 患者颈椎 X 线片的实用性以及临床实践指南，以确保对 RA 患者进行适当和具有成本效益的围手术期颈椎评估和管理。
