Anesthesia for cervical spinal cord injury

Anesthesiologists are involved in the care of acute cervical spinal cord injury (SCI) patients related to blunt and penetrating trauma, as well as perioperative injuries resulting from spine surgery and/or preexisting spondylosis. Knowledge of the ASIA injury scale classification and epidemiology of associated injuries helps the anesthesiologist to prioritize management of these complex patients according to the most recent guidelines. Steroids should no longer be used as neuroprotective agents. Early surgical decompression and spinal stabilization is gaining favor. Manual in-line stabilization remains recommended while cricoid pressure during intubation is not. Videolaryngoscopes are increasingly utilized, but fiberoptic intubation remains the gold standard when applicable. Neurogenic shock requires attentive hemodynamic and bradyarrhythmia management. Central neuropathic pain is a common and difficult to manage entity in SCI.