96 - 100 SBAs for the Final FRCA
Question 96
A 47 year old woman undergoes emergency anterior cervical decompression for an incomplete C5 spinal cord injury after a road traffic accident. You've taken her to the intensive care unit ventilated, and are asked why you didn't wake her up given her arterial blood gas was essentially normal.
Which is the most appropriate explanation?
- She is likely to be in severe pain if woken up immediately after surgery
- Respiratory failure can occur during the first 48 to 72 hours due to evolving cord oedema
- Delayed airway oedema is common following anterior surgery
- High cervical injuries invariably require lifelong ventilation
- Postoperative sedation improves neurological recovery
Answer
- Respiratory failure can occur during the first 48 to 72 hours due to evolving cord oedema
Cervical spinal trauma can lead to delayed cord swelling which takes up to 72 hours to make itself known. A patient may initially have adequate respiratory function but then progress to needing mechanical ventilation.
- There's no reason a patient with adequate multimodal analgesia would not be sufficiently comfortable to wake up after anterior cervical surgery
- Airway oedema is certainly possible, but not the most appropriate answer
- High spinal cord lesions often do need mechanical ventilation but for an injury at C5 this isn't guaranteed at this stage
- Patients generally do better neurologically when sedation is kept to a minimum