Segmental Cervical Spine Movement with the Intubating Laryngeal Mask During Manual In-Line Stabilization in Patients with Cervical Pathology Undergoing Cervical Spine Surgery

Kihara, Shinichi; Watanabe, Seiji; Brimacombe, J.; Taguchi, Noriko; Yaguchi, Yuichi; Yamasaki, Yonosuke

doi:10.1097/00000539-200007000-00037

Cited by 23 publications

(18 citation statements)

References 8 publications

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“…However, the degree of cervical extension during laryngoscopy is important. The previous literature reported extension at C1/2 produced with ILMAs ranging from 1° to 5° and even as high as 7.4° [6,[10][11][12]. Our result is in line with this range.…”

Section: Discussionsupporting

confidence: 92%

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

Inan¹,

Bedirli²,

Şatirlar³

2019

Turk J Med Sci

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Background/aim: The optimal technique for airway management in patients with cervical pathology remains unclear. Intubating laryngeal mask airway devices such as LMA CTrach and LMA Fastrach have not been compared for cervical spine (C-spine) movements in the context of cervical pathology. The present study aimed to determine upper C-spine movements by radiography during intubation with different devices as well as comparing the duration and success of intubation in cervical surgery. Materials and methods: Sixty patients scheduled for elective cervical surgery were registered in this prospective, randomized study. Patients with cervical trauma/injury, previous neck surgery, and body mass index (BMI) of >35 kg/m 2 were excluded. Participants were randomized to one of the 3 groups: LMA CTrach, LMA Fastrach, or the Macintosh laryngoscope. C-spine motion was evaluated by measuring angles created by bordering vertebrae at cervical 1/2 and 2/3 (C1/2, C2/3) segments on 2 lateral cervical radiographs for each patient. Intubation time, ease of intubation, number of attempts, and success rate were also documented. Results: Demographic data were similar in all the groups. The cervical movement with LMA CTrach and LMA Fastrach compared to the Macintosh laryngoscope were similar at C1/2. However, LMA CTrach significantly reduced extension compared to LMA Fastrach and Macintosh laryngoscopes at C2/3. Duration of intubation was significantly shorter with the Macintosh laryngoscope. The rate of successful intubation was 80% with LMA Fastrach and 100% with both LMA CTrach and the Macintosh laryngoscopes. Conclusion: The LMA CTrach laryngoscopy involves less upper C-spine movement than the LMA Fastrach and does not increase the duration of the intubation period.

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Section: Discussionsupporting

confidence: 92%

“…Previous radiographic and fluoroscopic studies, purporting to evaluate C-spine movement during intubation with various intubating techniques, were carried out. [4,6,[9][10][11][12]. Intubating laryngeal mask airways have been compared for the success of tracheal intubation [13,14].…”

Section: Introductionmentioning

confidence: 99%

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

Inan¹,

Bedirli²,

Şatirlar³

2019

Turk J Med Sci

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“…34-39 The impact of the ILMA technique on cervical spine extension at C1-2 has also been reported from less than 1° to 5°. 40-42 …”

Section: Discussionmentioning

confidence: 99%

A Comparison of 4 Airway Devices on Cervical Spine Alignment in Cadaver Models of Global Ligamentous Instability at C1-2

Wendling¹,

Tighe²,

Conrad

et al. 2013

Anesthesia &Amp; Analgesia

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Background The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain. Methods To examine the potential for mechanical disruption during endotracheal intubation in cadavers with unstable cervical spines, we performed a prospective observational cohort study with three cadaver subjects. We created an unstable, type II odontoid fracture with global ligamentous instability at C1-2 in lightly embalmed cadavers, followed by repetitive intubations with four different airway devices (Airtraq laryngoscope, Lightwand, intubating LMA, and Macintosh laryngoscope) while manual in-line stabilization was applied. Motion analysis data were collected using an electromagnetic device to assess the degree of angular movement in three axes (flexion-extension, axial rotation and lateral bending) during the intubation trials with each device. Intubation was performed by either an emergency medical technician or attending anesthesiologist. Results Overall, 153 intubations were recorded with the four devices. The Lightwand technique resulted in significantly less flexion extension and axial rotation at C1-2 than with the intubating LMA (mean difference in flexion-extension 3.2 degrees [95% CI 0.9 to 5.5], p=0.003; mean difference in axial rotation 1.6 degrees [95% CI 0.3 to 2.8], p=0.01 and Macintosh laryngoscope (mean difference in flexion extension 3.1 degrees [95% CI 0.8 to5.4], p=0.005; mean difference in axial rotation 1.4 degrees [95% CI 0.1 to 2.6], p=0.03. Conclusions In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.

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“…The use of the ILMA in the known or potentially difficult airway was partially addressed in these initial trials 3,5,6 which included 78 such patients. Specific focus on this application occurred in 14 subsequent clinical trials [12][13][14][15][16][17][18][19][20][21][22][23][24][25] and numerous case reports , involving a total of 377 patients.…”

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confidence: 99%

Intubating Laryngeal Mask Airway

Caponas

2002

Anaesth Intensive Care

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The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.

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Segmental Cervical Spine Movement with the Intubating Laryngeal Mask During Manual In-Line Stabilization in Patients with Cervical Pathology Undergoing Cervical Spine Surgery

Cited by 23 publications

References 8 publications

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

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

A Comparison of 4 Airway Devices on Cervical Spine Alignment in Cadaver Models of Global Ligamentous Instability at C1-2

Intubating Laryngeal Mask Airway

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