Cervical spine motion during intubation: a fluoroscopic comparison between three intubation techniques

Ghandour, Moutaz Abdel Mohsen; El-Gamal, Nader; Ammar, Ramadan A; Elnekeidy, Abd El Aziz Mohamed

doi:10.4103/roaic.roaic_13_17

Cited by 1 publication

(3 citation statements)

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“…However, there is controversy regarding cervical spine motion during tracheal intubation with direct laryngoscopes versus videolaryngoscopes. Similar to our study, a previous study demonstrated that the C-MAC D-Blade videolaryngoscope produced less cervical spine movement at the occiput-C1, occiput-C2, and occiput-C5 segments than the Macintosh laryngoscope [14]. 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].…”

Section: Discussionsupporting

confidence: 91%

“…In this study, the average cervical spine motion was 6.8°at the occiput-C1 segment during C-MAC D-Blade videolaryngoscopic intubation. Similarly, a previous study reported cervical spine motion of 5.0°at the same cervical segment during C-MAC D-Blade videolaryngoscopic intubation [14]. These cervical spine motions at the occiput-C1 segment seem to be less during intubation with the C-MAC D-Blade videolaryngoscope compared to other videolaryngoscopes, as shown in studies in which the average cervical spine motion at the occiput-C1 segment was 9.1-12.5°and 10.4°for GlideScope and McGrath MAC videolaryngoscopic intubation, respectively [4,15,19].…”

Section: Discussionsupporting

confidence: 65%

“…Unlike Macintosh laryngoscopic intubation, C-MAC D-Blade videolaryngoscopic intubation does not necessitate extreme neck extension for alignment of the three airway axes to visualize the glottis. Although a recent study demonstrated the superiority of the C-MAC D-Blade videolaryngoscope over the Macintosh laryngoscope in terms of cervical motion and glottis visualization, [14] the effect on cervical spine motion of C-MAC D-Blade videolaryngoscopy has not been investigated extensively.…”

Section: Introductionmentioning

confidence: 99%

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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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