A Comparison of 4 Airway Devices on Cervical Spine Alignment in Cadaver Models of Global Ligamentous Instability at C1-2

Wendling, Adam; Tighe, Patrick J.; Conrad, Bryan P.; Baslanti, Tezcan Ozrazgat; Horodyski, MaryBeth; Rechtine, Glenn R.

doi:10.1097/01.sa.0000441001.27668.be

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Other studies showed that the GlideScope, Airway Scope, King Vision™ videolaryngoscope, Airtraq videolaryngoscope, and McGrath series 5 videolaryngoscope were also associated with less cervical spine motion during intubation, at various cervical segments, compared to the Macintosh laryngoscope [3][4][5][6]17]. In contrast, other studies showed no significant difference in cervical spine motion between the direct laryngoscope and GlideScope in patients with manual in-line stabilization, or between the direct laryngoscope and Airtraq videolaryngoscope in a cadaver model of C1-C2 instability [15,18]. A possible explanation for this discrepancy is that differences in the extent of airway muscle relaxation and neck immobilization, the experience of intubator, the shape and length of the videolaryngoscopic blade, and the force needed to elevate the videolaryngoscopic blade upward and forward can cause differences in cervical spine motion.…”

Section: Discussionmentioning

confidence: 99%

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Paik

Park

2020

BMC Anesthesiol

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Background: Maintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization. Methods: In this randomized crossover study, the cervical spine angle was measured at the occiput-C1, C1-C2, and C2-C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation. Results: The cervical spine motion at the occiput-C1 segment was measured at 12.1 ± 4.2°and 6.8 ± 5.0°during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, − 5.3; 98.33% CI: − 8.8 to − 1.8; p = 0.001). However, there was no significant difference between the two intubation devices at the C1-C2 segment (− 0.6; 98.33% CI: − 3.4 to 2.2; p = 0.639) or C2-C5 segment (0.2; 98.33% CI: − 6.0 to 6.4; p = 0.929). Conclusions: The C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization. Trial registration: This study was registered at ClinicalTrials.gov on June 26, 2018 (NCT03567902).

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Section: Discussionmentioning

confidence: 99%

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Paik

Park

2020

BMC Anesthesiol

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“…Of these, the lightwand, a lighted stylet, is a useful device in patients with cervical instability because this device does not require neck extension to directly visualize the vocal cord. [7][8][9] However, use of the lightwand carries a risk of causing oral cavity injury because it is a blind technique. 8 In addition, the lightwand requires a jaw thrust maneuver for easier placement in the midline underneath the epiglottis.…”

Section: Introductionmentioning

confidence: 99%

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Kim

Yoon

et al. 2019

J Int Med Res

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ObjectiveThis study was performed to compare the use of a video laryngoscope-guided lightwand versus a single lightwand for tracheal intubation performed by non-experts in cervical spine-immobilized patients.MethodsIn total, 318 patients under general anesthesia were assigned either to the single lightwand group (Group L) or the video laryngoscope-guided lightwand group (Group VL) at a 1:1 ratio. First- or second-grade residents performed tracheal intubation with the assigned device after applying semi-hard fitted cervical collars to the patients. Outcomes, including the success rate and airway complications, were compared between the two groups.ResultsThere were no significant differences in demographics or airway-related characteristics between the two groups. The success rate of intubation on the first attempt was significantly higher in Group VL than in Group L (90% vs. 64%, respectively). Postoperative complications, including oral mucosal bleeding, hoarseness, and sore throat scores at 1 and 24 hours after surgery, were significantly lower in Group VL than in Group L.ConclusionsThe use of a video laryngoscope-guided lightwand for tracheal intubation can be useful for non-experts who encounter difficult airway situations.

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“…Cervical spine trauma tends not to be isolated to simply a fracture site. Ligamentous injury , surrounding tissue oedema and haematoma formation all play a role in the trauma patient. Transection of the cord or contusion during airway manipulation may also be important.…”

mentioning

confidence: 99%

Secondary cervical spine injury during airway management: beyond a ‘one-size-fits-all’ approach

Duggan

Griesdale

2015

Anaesthesia

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A Comparison of 4 Airway Devices on Cervical Spine Alignment in Cadaver Models of Global Ligamentous Instability at C1-2

Cited by 3 publications

References 2 publications

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Comparison between use of single lightwand and video laryngoscope-guided lightwand for tracheal intubation in simulated cervical spine-immobilized patients: a single-blind randomized study

Secondary cervical spine injury during airway management: beyond a ‘one-size-fits-all’ approach

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