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

Abstract

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. 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). 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. 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.