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LETTER TO THE EDITOR

Tetraplegia After Coronary Artery Bypass Grafting in a Patient with Undiagnosed Cervical Stenosis

Department of Anesthesiology, Ageo Central General Hospital, Ageo, Saitama, Japan, sususmu{at}db3.so-net.ne.jp

In Response:

I thank Naja et al. for their letter that suggests cervical injury could occur during cardiac surgery in operative situations other than ours (1). In both reports, neck position during surgery and latent cervical stenosis represented common risk factors for cervical injury.

The author recommends preoperative magnetic resonance image scanning or computed tomographic examination in elderly patients as a screening for detecting latent cervical supine stenosis. However, an infrequent prevalence in asymptomatic patients would not support the value of screening. The use of a tall headrest and a soft mat under the neck at the cost of surgical exposure of the chest seems to be the only practical way of avoiding cervical injury in elderly patients.

Reference

1. Fujioka S, Niimi Y, Hirata K, et al. Tetraplegia after coronary artery bypass grafting. Anesth Analg 2003;97:979–80.[Abstract/Free Full Text]

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