Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach and Macintosh laryngoscope

Inan, Gozde; Bedirli, Nurdan; Şatirlar, Zerrin Özköse

doi:10.3906/sag-1906-135

Cited by 4 publications

(11 citation statements)

References 21 publications

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“…Thirteen of 21 trials had a randomised crossover design 7–19. 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.…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…All patients were adults, with low risk of difficult airway, submitted to general anaesthesia in the operation theatre. Three trials included patients who underwent spine surgery, but all were free from myelopathic symptoms and instability 20 22 27…”

Section: Resultsmentioning

confidence: 99%

“…This segment was studied in 13 trials9 11 12 17 19–27 (figure 3 and online supplemental appendix J). ‘Alternative devices’ caused less cervical movement than MAC (MD of −2.38 (95% CI −3.17 to –1.58), I 2 =0%).…”

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Therefore, cervical immobilization with a cervical collar or manual in-line stabilization (MILS) is recommended to reduce cervical spine motion during intubation in patients at risk of cervical spine instability [3][4][5]. In addition, other devices, including videolaryngoscopes, lighted stylets, flexible fiberoptic bronchoscopes, and supraglottic airway devices, are commonly used in such patients instead of direct laryngoscopes to facilitate intubation and reduce cervical spine motion during intubation [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial

Kim

Hur

Yoon

et al. 2021

JCM

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We hypothesized that external laryngeal manipulation would reduce cervical spine motion during video laryngoscopic intubation under manual in-line stabilization by reducing the force required to lift the videolaryngoscope. In this randomized crossover trial, 27 neurointerventional patients underwent two consecutive videolaryngoscopic intubation attempts under manual in-line stabilization. External laryngeal manipulation was applied to all patients in either the first or second attempt. In the second attempt, we tried to reproduce the percentage of glottic opening score obtained in the first attempt. Primary outcomes were cervical spine motion during intubation at the occiput-C1, C1–C2, and C2–C5 segments. The intubation success rate (secondary outcome measure) was recorded. Cervical spine motion during intubation at the occiput-C1 segment was significantly smaller with than without external laryngeal manipulation (7.4° ± 4.6° vs. 11.5° ± 4.8°, mean difference −4.1° (98.33% confidence interval −5.8° to −2.3°), p < 0.001), showing a reduction of 35.7%. Cervical spine motion during intubation at the other segments was not significantly different with versus without external laryngeal manipulation. All intubations were achieved successfully regardless of the application of external laryngeal manipulation. External laryngeal manipulation is a useful method to reduce upper cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.

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Airway management in patients with suspected or confirmed traumatic spinal cord injury: a narrative review of current evidence

Wiles

2022

Anaesthesia

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Summary Around 1 million people sustain a spinal cord injury each year, which can have significant psychosocial, physical and socio‐economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the airway management of patients with confirmed or suspected traumatic spinal cord injury to promote best clinical practice. All airway interventions are associated with some degree of movement of the cervical spine; in general, these are very small and whether these are clinically significant in terms of impingement of the spinal cord is unclear. Manual in‐line stabilisation does not effectively immobilise the cervical spine and increases the likelihood of difficult and failed tracheal intubation. There is no clear evidence of benefit of awake tracheal intubation techniques in terms of prevention of secondary spinal cord injury. Videolaryngoscopy appears to cause a similar degree of cervical spine displacement as flexible bronchoscope‐guided tracheal intubation and is an appropriate alternative approach. Direct laryngoscopy does cause a slightly greater degree of cervical spinal movement during tracheal intubation than videolaryngoscopy, but this does not appear to increase the risk of spinal cord compression. The risk of spinal cord injury during tracheal intubation appears to be minimal even in the presence of gross cervical spine instability. Depending on the clinical situation, practitioners should choose the tracheal intubation technique with which they are most proficient and that is most likely to minimise cervical spine movement.

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Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach and Macintosh laryngoscope

Cited by 4 publications

References 21 publications

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

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

Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial

Airway management in patients with suspected or confirmed traumatic spinal cord injury: a narrative review of current evidence

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