GlideScope versus D-blade for tracheal intubation in cervical spine patients: A randomised controlled trial

Abstract

Background and Aims: Airway management in patients with cervical spine pathology is challenging. The aim of the study was to evaluate GlideScope (GVL) and D blade of C-MAC (CMAC-D) using manual inline axial stabilisation (MIAS) for tracheal intubation in patients with cervical spine injury/pathology. Methods: This is a randomised, single-blind, hospital-based study. After obtaining informed consent, 54 patients with cervical spine pathology/injury were grouped into GVL group or CMAC-D group, ( n = 27 each) based on computer-generated random number table. Preoperative airway difficulty score (ADS) was calculated. The primary outcome of the study was intubation difficulty score (IDS) and the secondary outcomes included total time taken to secure airway, failure to intubate, haemodynamic parameters and adverse events. Data was represented in the form of number (%) or mean and standard deviation and median and interquartile range as appropriate. Chi square test was used for analysing IDS. Results: The mean ± SD of IDS of the CMAC-D and GVL groups were 0.04 ± 0.2 (0.04–0.11) and 0.19 ± 0.40 (0.03–0.34), respectively, ( P value = 0.096). The number (%) of patients with IDS > 0 was 1 (3.7) in CMAC-D and 5 (18.5) in GVL group, ( P value = 0.192). Demographic data, ADS, Cormack–Lehane grading, success rate, time of tracheal intubation, type of surgeries, haemodynamic parameters and post-operative complications were similar in both the groups. Conclusion: Both GVL and CMAC-D with MIAS are equally efficacious in tracheal intubation in cervical spine injury/pathology patients without other difficult airway management criteria.

Implementation and adherence to a speciality-specific checklist for neurosurgery and its influence on patient safety

“…The implementation of the modified checklist in our study facilitated focussed actions pertinent to patient concerns specific for neurosurgery such as mechanical deep vein thrombosis prophylaxis; use of advanced airway aids for unstable cervical spine;[ 14 ] prevention of hypersensitivity/anaphylaxis to phenytoin;[ 15 ] use of osmotherapy and/or total intravenous anaesthesia (TIVA) for raised ICP; targeted anaesthetic titration for intraoperative neuromonitoring;[ 16 17 ] and point-of-care blood-gas analysis [Tables 3 and 4 ]. This attains further relevance in the context when neurosurgical cases are done by non-neuroanaesthesiologists.…”

Comparative study of the difficulty of endotracheal intubation in sniffing and 25-degree backup positions

“…It is usually a semi-urgent procedure. Before attempting intubation, a brief «pre-assessment» of the patient should be performed including numerous anatomic and clinical aspects and covering any potential airway difficulties, aspiration risk, and concomitant disorders in the identification of potentially difficult laryngoscopy [6,7].…”

Airway management in the adult patient with an unstable cervical spine

“…One of the emerging themes in recent papers has been the evaluations of different technologies for endotracheal intubation. Multiple papers [see Table 1[13 ▪ ,14,15 ▪ ,16,17,18 ▪ ,19–23,24 ▪ ,25 ▪ ]] published in the past 18 months have evaluated, with different preconditions and outcome measures, the efficacy or safety of different technologies for endotracheal intubation in the context of spinal instability. Most of these small studies attempted to answer the question of device superiority using various endpoints of cervical spine movement, such as angulation of vertebral components or measuring changes in canal diameter.…”