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Airway management of patients with cervical spine instability may be difficult as a result of immobilization, and may be associated with secondary neurologic injury related to cervical spine motion. Spinal cord instability is most common in patients with trauma, but there are additional congenital and acquired conditions that predispose to subacute cervical spine instability. Patients with suspected instability should receive immobilization during airway management with manual in-line stabilization. The best strategy for airway management is one that applies the technique with the highest likelihood of success on the first attempt and the lowest biomechanical influence on a potentially unstable spine.

Background This study evaluated the type and need for angioplasty in 253 consecutive carotid endarterectomies. Methods Polyester knitted gelatin sealed patch (DP) and polytetrafluoroethylene (PTFE) patches were used in, respectively, 159 and 29 patients, with 65 vessels closed primarily (no patch [NP]). Results Surgical results, estimated blood loss, and surgical time were similar in each group. Postoperative hematomas occurred in 6 DP and 3 NP patients. There were 3 strokes in the DP group. Long-term duplex evaluation was possible in 201 patients. The number of patients who had less than 15%, 15% to 50%, 50% to 79%, 80% to 99%, 100%, or an ungraded degree of narrowing were as follows for each group: DP, 117, 2, 5, 0, 1, and 2; PTFE, 18, 1, 1, 0, 0; and NP, 53, 0, 0, 0, 1. Statistical analysis failed to show any difference between groups postoperatively or in long-term follow-up evaluation. Conclusions It appears that selective patching is safe and effective in male patients who undergo carotid endarterectomy. The type of patch material also is inconsequential. Patch type and its use should be at the surgeon’s discretion.

Background This study focused on 200 carotid endarterectomies (CEA) performed at our Veterans Administration Hospital (VAH) to determine whether 1-day hospitalization after CEA is safe and the degree to which it can be achieved. Methods Over 36 months, 200 CEAs were performed for asymptomatic stenosis (n = 104), transient ischemic attacks (n = 68), and stroke (n = 28). General anesthesia was used in 189 procedures. Results The hospital stay was 1 day for 132 procedures and more than 1 day in 68 CEAs. The average stay was 1.69 ± 1.5 days. After surgery there were 3 strokes, 5 hematomas that required evacuation, and 5 myocardial infarctions. There were no deaths. Four patients were readmitted in the 1-day and the greater than 1-day stay groups. History of myocardial infarction, renal insufficiency, longer operative time, and complications correlated with a greater than 1-day stay (P Conclusion A 1-day hospital stay is safe and practical in a VAH setting, resulting in good clinical outcomes.