Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

Waltl, Barbara; Melischek, Matthias; Schuschnig, C.; Kabon, Barbara; Erlacher, Wolfgang; Našel, Christian; Fuchs, Mary Anne; Kapral, Stephan

doi:10.1046/j.1365-2044.2001.01869.x

Cited by 56 publications

(35 citation statements)

References 25 publications

(43 reference statements)

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“…[5][6][7][8][9][10][11][12] Recently, studies of the lighted intubating stylet (Trachlight®) and Bonfils® Stylet have been published. 4,13 Only the Trachlight has been shown to reduce C-spine movement without a significant increase in laryngoscopy duration; however the Trachlight involves a blind technique.…”

Section: Résultats : Le Mouvement De La Colonne Cervicale éTait En Momentioning

confidence: 99%

Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope

Turkstra

Pelz²,

Shaikh

et al. 2007

Can J Anesth/J Can Anesth

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Purpose:The optimal technique to manage the airway in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using fluoroscopic video assessment, C-spine motion during laryngoscopy with a Shikani Optical Stylet® (SOS) was compared to C-spine motion during intubation using a Macintosh blade.Methods: Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and Shikani laryngoscopy with manual inline stabilization following induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryngoscopy was also measured (duration > 120 sec was deemed a failure of the laryngoscopy technique). Results:On average, C-spine motion was 52% less (P < 0.02) at three of the motion segments studied, occiput-C1, C2-C5, and C5-thoracic when comparing SOS vs Macintosh laryngoscopy. There was no difference between techniques at the C1-C2 segment. Laryngoscopy with SOS (28 ± 17 sec) took longer than with Macintosh blade (17 ± 7 sec), P < 0.01. There were two failures out of 23 using the SOS, vs none with the Macintosh blade. Conclusion:For patients in whom C-spine movement is undesirable, use of the SOS may limit neck movement, while modestly increasing the time required to intubate, and/or the risk of procedure failure.

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Section: Résultats : Le Mouvement De La Colonne Cervicale éTait En Momentioning

confidence: 99%

Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope

Turkstra

Pelz²,

Shaikh

et al. 2007

Can J Anesth/J Can Anesth

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“…It has additional advantages, as noted by previous studies, such as easy insertion, high first intubation success rates and the ability of oxygenation and ventilation throughout the procedure (24)(25)(26). The intubating laryngeal mask produces segmental movement of the C-spine when applied with manual in-line stabilisation in patients with C-spine pathology (27).…”

Section: Discussionmentioning

confidence: 94%

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

Şahin

Arslan

Akansel

et al. 2018

Turk J Anaesth Reanim

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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...

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“…Even though direct laryngoscopy is the fastest method, it was shown to increase the cervical spine movement more than videolaryngoscopes and the ILMA fluoroscopically (5,15,16). In addition, ILMA was recommended as a second choice in these situations in previously published literature and the Advanced Trauma Life Support guidelines (3,6).…”

Section: Discussionmentioning

confidence: 99%

“…Direct laryngoscopy has decreased intubation success and increased cervical spine motion when compared to an intubating laryngeal mask airway (ILMA) fluoroscopically (5). If a cervical spine injury is suspected, nasal or oral awake fiberoptic intubation must be the first choice in elective procedures, but this technique needs skill and takes time; alternatively, blind intubation with ILMA and minimal optimization maneuvers is recommended (6).…”

Section: Introductionmentioning

confidence: 99%

Tracheal intubation in patients immobilized by a rigid collar: a comparison of GlideScope and an intubating laryngeal mask airway*

Özdil¹,

Aydın²,

Baykara³

et al. 2016

Turk J Med Sci

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Background/aim: Intubation must be rapidly performed with the utmost care in cervical trauma patients. We present the first comparison of GlideScope and an intubating laryngeal mask airway (ILMA) regarding insertion and intubation times, intubation success rates, mucosal damage, need for optimization maneuvers, effects on hemodynamic changes, and postoperative minor complications in a simulated cervical injury with a Philadelphia cervical collar. Materials and methods:Ethics committee approval and patient consent were obtained and 94 American Society of Anesthesiology physical status I or II patients were enrolled in this study. Following standard anesthesia monitoring and induction, the Philadelphiatype cervical collar was applied and patients were subsequently intubated with ILMA or GlideScope. Results:The total intubation success rates were similar between the groups (96%). The insertion (14.9 ± 10 s vs. 21.9 ± 6.5 s, respectively; P < 0.001) and intubation (43.5 ± 13 s vs. 48.4 ± 11 s; P = 0.02) times for ILMA were longer than for GlideScope. The total intubation times for ILMA were longer than the intubation time for GlideScope (43.5 ± 13 s vs. 85.6 ± 13 s; P < 0.001). The mucosal damage was higher in the ILMA group (P = 0.04). The two airway devices increased the heart rate and mean arterial pressure after insertion compared with the postinduction values within groups. Conclusion:GlideScope is superior to ILMA in terms of lower insertion and intubation times and lower levels of mucosal damage in cervical collar-immobilized patients.

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Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

Cited by 56 publications

References 25 publications

Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope

Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope

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

Tracheal intubation in patients immobilized by a rigid collar: a comparison of GlideScope and an intubating laryngeal mask airway*

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