Fluoroscopic Comparison of Cervical Spine Motion Using LMA CTrach, C-MAC Videolaryngoscope and Macintosh Laryngoscope

Abstract

Objective: Endotracheal intubation should be performed with care when cervical spine (C-spine) injury is suspected. The aim of this study was to evaluate the movement of the C-spine using fluoroscopy during intubation with Laryngeal Mask Airway (LMA) CTrach, C-MAC videolaryngoscope and Macintosh laryngoscope. Methods: This was a single-centre, prospective, observational, controlled trial. In total, 22 surgical patients aged 18-65 years planned to undergo operation under general anaesthesia, were enrolled. X-ray images of the C-spine were obtained using fluoroscopy with the patients' head in a neutral position. All patients underwent laryngoscopy using a Macintosh blade, LMA CTrach and C-MAC videolaryngoscope, and fluoroscopic images of the C-spine were obtained. All the patients were intubated at the last laryngoscopy simulation (using the C-MAC). The atlanto-occipital distance (AOD) and angles between C 0 C 1 , C 0 C 2 , C 0 C 3 , C 0 C 4 , C 1 C 2 and C 2 C 3 lines were measured and compared between each device. Results: The mean AOD was measured as 20.4 mm in a neutral position, which decreased to 13.1, 17.2 and 12.3 mm after the insertion of the Macintosh laryngoscope, LMA CTrach and C-MAC videolaryngoscope, respectively. The differences were significant (p<0.001). Moreover, significant difference was noted in C 0 C 2 , C 0 C 3 and C 1 C 2 angles with the insertion of the three devices (p<0.001). The LMA CTrach resulted in significantly lesser C-spine movements in C 0 C 2 , C 0 C 3 and C 0 C 4 angles compared to the Macintosh laryngoscope and C-MAC videolaryngoscope (p<0.001). Conclusion:The LMA CTrach resulted in lesser C-spine movements compared to Macintosh laryngoscope and C-MAC videolaryngoscope. In case of the C-spine injury, LMA CTrach may be preferred and may cause fewer traumas during endotracheal intubation. Keywords: Cervical spine motion, LMA C Trach, videolaryngoscopy, fluoroscopy Amaç: Servikal omurga hasarından şüphelenildiğinde endotrakeal entübasyon dikkatli yapılmalıdır. Bu çalışmanın amacı LMA (Laryngeal Mask Airway) CTrach, C-MAC Videolaringoskop ve Macintosh Laringoskop ile entübasyon sırasında floroskopi ile servikal omurga hareketini değerlendirmektir. Yöntemler: Bu tek merkezli, prospektif, gözlemsel kontrollü bir çalışmaydı. Çalışmaya 18-65 yaşları arasında genel anestezi altında operasyon uygulanan 22 hasta dahil edildi. Endotrakeal entübas-yondan önce, hastanın başı nötr konumda iken servikal omurga floroskopi görüntüleri elde edildi. Tüm hastalarda standart Macintosh laringoskop, LMA CTrach ve C-MAC Videolaringoskop kullanıldı. Laringoskopi simülasyonları sırasında servikal omurgadaki değişikliklerin floroskopik görüntüleri elde edildi. Tüm hastalar son laringoskopi sırasında C-MAC kullanılarak entübe edildi. Floroskopi görüntüleri üzerinde C 0 C 1 , C 0 C 2 , C 0 C 3 , C 0 C 4 , C 1 C 2 ve C 2 C 3 arasındaki Atlantooksipital mesafeler ve açılar ölçüldü ve aradaki farklar cihazlar arasında karşılaştırıldı. Bulgular: Ortalama Atlantooksipital mesafe, nötral pozisyonda 20,4 mm ölçül...

Airway management in patients with suspected or confirmed cervical spine injury

“…radiologically in patients having their tracheas intubated for elective surgery with either LMA CTrach, C-MAC or direct laryngoscopy with a Macintosh blade. They reported that motion at all levels measured (C0-C3) was lower with the LMA CTrach, though the clinical significance of this was unclear [37]. Macintosh laryngoscope [38].…”