Cervical Spine Motion During Tracheal Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus GlideScope® Videolaryngoscopy

Robitaille, Arnaud; Williams, Stephan; Tremblay, Marie-Hélène; Guilbert, F; Thériault, Mélanie; Drolet, Pierre

doi:10.1213/ane.0b013e318161769e

Cited by 170 publications

(82 citation statements)

References 30 publications

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“…32 Recently, Robitaille et al reported a 35% incidence of grade 3 laryngoscopic view with MILS and direct laryngoscopy. 33 Some direct and indirect evidences that MILS increases the rate of failed and difficult tracheal intubations have been reported by Santoni et al 34 In human volunteers, they observed that the pressure applied by the laryngoscope blade with MILS doubled compared to control, an indirect indication that glottic view deteriorates with MILS. Moreover, such pressure may be transmitted to the cervical spine and may increase movements that MILS is trying to prevent.…”

Section: Discussionmentioning

confidence: 89%

“…The actual tracheal intubation failure rate may not be as high as 50%, but it is clear from this data and from other studies that MILS significantly increases the rate of difficult tracheal intubation with direct laryngoscopy. 3,4,[32][33][34] Limitations Only 200 of the original 510 patients were included in the study. Although an interim analysis was not planned a priori, it became mandatory when the anesthesiologists participating in the study strongly believed there was a marked difference in the tracheal intubation failure rate between the two groups.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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show abstract

“…Unlike direct laryngoscopy, it does not require to sort the laryngeal, pharyngeal and oral axes. Earlier studies have reported that videolaryngoscopy provides advantage in patients with obesity or cervical spinal stabilization [2,3]. Intubation with fiber optic bronchoscopy has been successfully used in patients with limited mouth opening as well as in the ones with cervical motion restriction.…”

Section: Editorialmentioning

confidence: 99%

Combined Techniques in Difficult Airway Management

Saraçoğlu¹

2014

Glob J Anesth

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“…(Lovich-Sapola, 2010) The use of a Glidescope with in-line stabilization has been shown to provide better glottic visualization, but does not significantly decrease the movement of the cervical spine when compared to direct laryngoscopy. (Robitaille, 2008) If the cervical collar was removed during intubation, it should be replaced immediately after the intubation is confirmed. (Lovich-Sapola, 2010) 4.…”

Section: In-line Stabilizationmentioning

confidence: 99%