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Background: There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting., Methods: An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012-June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury., Results: We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors., Conclusions: It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury., (© 2024 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

A simulated cardiopulmonary bypass circuit was constructed in the laboratory to compare the accuracy and precision of a new non-invasive extracorporeal oxygen saturation monitor-- the M3 monitor (Spectrum Medical LLP, Gloucester, UK) against the Siemens RAPIDLab(®) blood gas analyser (Siemens AG, Munich, Germany). Comparisons were made across a range of oxygen saturations and at different temperatures and different haemoglobin concentrations. Results showed that under all conditions, when recording oxygen saturation, the M3 monitor achieved a mean (SD) bias of -0.9 (1.7)% with limits of clinical agreement of -4.2 to 2.5. However, the difference between the two monitors was larger at lower saturation levels (p < 0.001), lower haemoglobin levels (p = .002) and lower temperatures (p = 0.013). The mean (SD) haemoglobin concentration was 15.4 (0.6) when recorded by the M3 monitor, compared to 15.4 (0.5) g.dl(-1) measured by the blood gas analyser The M3 monitor compares favourably with the gold standard of the blood gas analyser and has the advantage of giving a continuous reading. You can respond to this article at http://www.anaesthesiacorrespondence.com., (© 2011 The Authors Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.)