Airtraq® vs. fibreoptic intubation in patients with an unstable cervical spine fracture: A neurophysiological study

Abstract

BackgroundFibreoptic intubation is described as the preferred technique for the non-urgent airway control in patients with an unstable cervical spine injury. Indirect laryngoscopes offer promising advantages, but their safety and impact on cervical spine movement is still discussed. AimWe compared the incidence of significant neurophysiologic modifications associated with tracheal intubation performed randomly by an Airtraq® videolaryngoscope contrasted with asleep fibreoptic intubation in 40 patients with a traumatic unstable cervical spine fracture immobilized by a moulded cervical collar and scheduled for elective surgery. MethodsSomatosensitive evoked potentials (SSEPs) monitoring was performed at four stages: before airway management (baseline), during facemask ventilation, during intubation and after definitive positioning for surgery. Time, ease of intubation, number of attempts and grade view laryngoscopy were also recorded. ResultsSignificant neurophysiological modifications were detected in one patient in each group during intubation. They were also identified during ventilation in 1/40 patients and 13/40 patients after positioning. Intubation times were significantly shorter when performed by an Airtraq® (median [25th;75th] 45 s [41;54]) than by fiberscope (124 [88;152]), (p < 0.001), and no external manoeuvres were required (vs 18/20 fiberscope group). None of the patients with significative SSEPs modification presented a worsening of their neurological status at discharge. ConclusionTracheal intubation with an Airtraq® appears to be a viable alternative to fibreoptic intubation in patients with a traumatic cervical spine fracture and immobilized by a moulded cervical collar. Time necessary to secure an airway in these patients is significantly shorter with the Airtraq®.