Comparison of Flexiblade™ and Macintosh laryngoscopes: cervical extension angles during orotracheal intubation

Uzun, Şennur; Erden, İsmail; Pamuk, Almıla Gülsün; Yavuz, Kivilcim; Çekirge, Saruhan; Aypar, Ülkü

doi:10.1111/j.1365-2044.2010.06370.x

Cited by 5 publications

(5 citation statements)

References 24 publications

(27 reference statements)

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“…[591011] Uzun et al ., found a rotation of 19° at C 1 –C 2 level when using Macintosh laryngoscope which is close to the instability limit of >20°. [1718] In the present study also, Macintosh laryngoscope produced maximum extension at the C 1 –C 2 , C 2 –C 3 , and atlantooccipital joints.…”

Section: Discussionsupporting

confidence: 65%

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes

Bhardwaj

Jain

Rao

et al. 2013

J Anaesthesiol Clin Pharmacol

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Background:Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope.Materials and Methods:A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was performed twice in each patient using in turn both the Macintosh and Truview laryngoscopes. A baseline radiograph with the head and neck in a neutral position was followed by a second radiograph taken during each laryngoscopy. An experienced radiologist analyzed and measured the cervical movement.Results:Significant cervical spine movement occurred at all segments when compared to the baseline with both the Macintosh and Truview laryngoscopes (P < 0.001). However, the movement was significantly less with Truview compared to the Macintosh laryngoscope at C0–C1 (21%; P = 0.005) and C1–C2 levels (32%; P = 0.009). The atlantooccipital distance (AOD) traversed while using Truview laryngoscope was significantly less than with Macintosh blade (26%; P = 0.001). Truview blade produced a better laryngoscopic view (P = 0.005) than Macintosh blade, but had a longer time to laryngoscopy (P = 0.04).Conclusion:Truview laryngoscope produced a better laryngoscopic view of glottis as compared with Macintosh laryngoscopy. It also produced significantly less cervical spine movement at C0–C1 and C1–C2 levels than with Macintosh laryngoscope in patients without cervical spine injury and without manual in-line stabilization (MILS). Further studies are warranted with Truview laryngoscope using MILS.

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Section: Discussionsupporting

confidence: 65%

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes

Bhardwaj

Jain

Rao

et al. 2013

J Anaesthesiol Clin Pharmacol

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“…One four-arm crossover trial involved a comparison between Bullard and MAC with and without manual in-line stabilisation (MILS),7 and three trials involved a comparison of three devices 20–22. Data were presented for laryngoscopy only in 8 trials,7 8 10 13–16 18 laryngoscopy and ETI in 1011 12 17 20 21 23–27 and ETI only in 3 9 19 22. Regarding immobilisation techniques, MILS was used in two trials,7 14 medical tapes and/or Velcro in two,12 26 cervical collar in two8 19 and not reported in one 27.…”

Section: Resultsmentioning

confidence: 99%

“…This segment was studied in 15 trials (figure 3 and online supplemental appendix F). 7 8 10 12–18 20 23–25 27 ‘Alternative devices’ caused less cervical movement than MAC (MD of −3.19 (95% CI −4.04 to –2.35), I 2 =36%).…”

Section: Resultsmentioning

confidence: 99%

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Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis

Correa

Felice²,

Sbruzzi³

et al. 2022

Emerg Med J

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BackgroundAirway management is challenging in trauma patients because of the fear of worsening cervical spinal cord damage. Video-integrated and optic-integrated devices and intubation laryngeal mask airways have been proposed as alternatives to direct laryngoscopy with the Macintosh laryngoscope (MAC). We performed a meta-analysis to clarify which devices cause less cervical movement during airway management.MethodsWe searched MEDLINE, Cochrane Central, Embase and LILACS from inception to January 2022. We selected randomised controlled trials comparing alternative devices with the MAC for cervical movement from C0 to C5 in adult patients, evaluated by radiological examination. Additionally, cervical spine immobilisation (CSI) techniques were evaluated. We used the Cochrane Risk of Bias Tool to evaluate the risk of bias, and the principles of the Grading of Recommendations, Assessment, Development, and Evaluations system to assess the quality of the body of evidence.ResultsTwenty-one studies (530 patients) were included. Alternative devices caused statistically significantly less cervical movement than MAC during laryngoscopy with mean differences of −3.43 (95% CI −4.93 to –1.92) at C0–C1, −3.19 (–4.04 to –2.35) at C1–C2, −1.35 (−2.19 to −0.51) at C2–C3, and −2.61 (–3.62 to –1.60) at C3–C4; and during intubation: −3.60 (–5.08 to –2.12) at C0–C1, −2.38 (−3.17 to −1.58) at C1–C2, −1.20 (–2.09 to –0.31) at C2–C3. The Airtraq and the Intubation Laryngeal Mask Airway caused statistically significant less movement than MAC restricted to some cervical segments, as well as CSI. Heterogeneity was low to moderate in most results. The quality of the body of evidence was ‘low’ and ‘very low’.ConclusionsCompared with the MAC, alternative devices caused less movement during laryngoscopy (C0–C4) and intubation (C0–C3). Due to the high risk of bias and the very low grade of evidence of the studies, further research is necessary to clarify the benefit of each device and to determine the efficacy of cervical immobilisation during airway management.

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“…[ 10 12 13 14 ] Uzun et al . [ 15 ] and Panjabi et al . [ 16 ] defined the instability limits as rotation of >20° in the sagittal plane.…”

Section: Discussionmentioning

confidence: 99%

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes

Kaur,

Raja,

Kumar

et al. 2023

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aim: Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a “line of sight.” Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. Material and Methods: A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Results: Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2–C3 and C0–C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). Conclusion: We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

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Comparison of Flexiblade™ and Macintosh laryngoscopes: cervical extension angles during orotracheal intubation

Cited by 5 publications

References 24 publications

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes

Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes

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