Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation

Abstract

BackgroundFor patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar.MethodsAnesthesia was induced with propofol, remifentanil, and rocuronium. After a Philadelphia cervical collar applied, patients were randomly assigned to tracheal intubation with an Airtraq (Group A, n = 25) or with conventional laryngoscopy (Group L, n = 25). Measurements included intubation time, success rate of first intubation attempt, number of intubation attempts, and percentage of glottic opening (POGO) score. Mean blood pressure and heart rate were also recorded at baseline, just before and after intubation.ResultsThe success rate of the first attempt in Group A (96%) was significantly greater than with the Group L (40%). POGO score was significantly greater in Group A (84 ± 20%) than in Group L (6 ± 11%). The duration of successful intubation at first tracheal intubation attempt and hemodynamic changes were not significantly different between the two groups.ConclusionsThe Airtraq offers a better laryngeal view and higher success rate at first intubation attempt in patients who are applied with a Philadelphia cervical collar due to suspicion of cervical spine injury.

Comparison of Airtraq™, McCoy™ and Macintosh laryngoscopes for endotracheal intubation in patients with cervical spine immobilisation: A randomised clinical trial

“…[3] A better success rate of intubation was reported[15] with Airtraq™ in patients with cervical immobilisation with the application of rigid cervical collar. In our study MIAS technique was used instead of cervical collar, which restricts mouth opening.…”

A randomised, controlled trial comparing the Airtraq™ optical laryngoscope with conventional laryngoscopy in infants and children*

“…Most of the research in adults does not demonstrate longer intubation times for the Airtraq compared with conventional laryngoscopy and the reason for this remains unclear; it may be for the reasons described above (less posterior displacement of the tracheal tube; greater familiarity because adult sizes have been available for longer), or there may be anatomical differences, as there is far greater variation in the size of paediatric airways compared with adults. Reports in adults show improved ease of tracheal intubation [4,5,24], improved laryngeal view [7,[25][26][27], less movement of the cervical spine and fewer alterations in heart rate [4][5][6]28]. The paediatric Airtraq (in infant and child sizes) has not been formally evaluated in children with difficult airways and information is limited to a few case reports, not all of which resulted in successful intubation [11][12][13][14]22].…”

Comparison of the C-MAC®and GlideScope®videolaryngoscopes in patients with cervical spine disorders and immobilisation

“…In simulated [8,9] or clinical settings [10,11] of restricted neck mobility, videolaryngoscopes have performed well. However, we are unaware of a clinical trial in patients with cervical spine pathology comparing the two videolaryngoscopes C-MAC â (Karl Storz, Tuttlingen, Germany) and GlideScope â (Verathon, Bothell, Washington, DC, USA) and our aim was to do this.…”