Preoperative preparation - Ask the surgeon if he/she is going to want the patient to move their extremities before extubation. If yes, then make sure to prepare the patient for that experience. Intubation - Glidescope or fiberoptic intubation are often employed because the patient has an unstable C-spine. Make sure to keep the patient's head in a neutral position! Shared airway - The surgeon will be working in close quarters with the airway, so you'll need to make sure you have it properly secured and have a backup plan! Your access to the airway will be limited. Because of the proximity of the surgery to the airway, there is also relatively high potential for accidental extubation by surgeons/fluoroscopy. Approach - SSEPs & MEPs are not always monitored. Make sure to check with the surgeon and/or team prior to preparing your approach. Time and Blood Loss - could be minimal to high depending on the surgeon and how many levels are being worked on. Wakeup - SMOOTH wakeup is important! Coughing can cause serious bleeding. One of the pros suggests 25mg of lidocaine IV during emergence and if necessary, 10-20mg bumps of propofol while the gas wears off. Postop - Watch closely for airway swelling and/or bleeding.
