Cervical Injury after Videolaryngoscopy in Patient with Ankylosing Spondylitis: Comment

Abstract

T he recent article by Epaud et al. 1 reinforces the need for anesthesiologists to be comfortable with the flexible fiberoptic intubation technique. I read with great concern that a neurologic injury occurred because of the choice of videolaryngoscopy as the intubation approach because the operator was more familiar with that technique. Was the decision to use videolaryngoscopy a result of our anesthesiology training programs shifting the focus of difficult airway training to videolaryngoscopy because this technique is readily available and relatively easy to use compared to flexible fiberoptic intubation? It has been demonstrated that videolaryngoscopy does not significantly reduce cervical spine movement compared to direct laryngoscopy 2 and, unfortunately, patient harm occurred in the authors' case presentation.The authors endorse that flexible fiberoptic intubation could have been used to avoid injury; the use of fiberoptic intubation mitigates cervical spine movement because it is flexible and can be manipulated in difficult anatomy presentations. A randomized clinical trial showed that there was no difference in intubation time and success rate 3 between videolaryngoscopy and flexible fiberoptic intubation in experienced hands. That is the key: experience! Anesthesiology residency programs should not compromise training in flexible fiberoptic intubation because of the relative ease of use and convenience of videolaryngoscopy, and American Board of Anesthesiology/Accreditation Council for Graduate Medical Education requirements should reflect this.

Cervical Injury after Videolaryngoscopy in Patient with Ankylosing Spondylitis: Reply

“…We thank Drs. Hindman and Dexter 1 and Dr. Cometa 2 for their interest in our image in clinical medicine relaying a cervical spine injury secondary to videolaryngoscopy. 3…”

“…Cometa 2 for their interest in our image in clinical medicine relaying a cervical spine injury secondary to videolaryngoscopy. 3 The main purpose of this image is educative, highlighting airway management in patients with ankylosing spondylitis as well as limits of the use of videolaryngoscopy.…”

Cervical Injury after Videolaryngoscopy in Patient with Ankylosing Spondylitis: Comment

“…Clinical studies in which cervical spine mobility is artificially restricted-using either manual in-line stabilization or cervical collars-indicate that compared to conventional direct laryngoscopy, videolaryngoscopy: (1) improves glottic view with most but not all videolaryngoscopes and (2) increases first-attempt intubation success with only a few (n = 5) videolaryngoscopes but is not 100%. 2 In two reports of 20 and 30 patients with ankylosing spondylitis in whom the GlideScope (Verathon, USA) was used for intubation, it was not possible to visualize the glottis in 13 to 15% or intubate in 7 to 15%. 3,4 The second message is that techniques intended to limit cervical spine motion during intubation can have adverse effects.…”