Abstract
AbstractThere have been growing concerns following documented instances of neurological deterioration in patients with cervical spine injury as a result of intubation. A significant body of evidence has since evolved with the primary objective of ascertaining the safest way of securing the endotracheal tube in patients with suspected and proven cervical injury. The search for a mode of intubation producing the least movement at the cervical spine is an ongoing process and is limited by logistic and ethical issues. The ensuing review is an attempt to review available evidence on cervical movements during intubation and to comprehensively outline the movement at the cervical spine with a wide plethora of intubation aids. Literature search was sourced from digital libraries including PubMed, Medline and Google Scholar in addition to the standard textbooks of Anaesthesiology. The keywords used in literature search included ‘cervical spine motion,’ ‘neurological deterioration,’ ‘intubation biomechanics,’ ‘direct laryngoscopy,’ ‘flexible fibreoptic intubation,’ ‘video laryngoscopes’ and ‘craniocervical motion.’ The scientific information in this review is expected to assist neuroanaesthesiologists for planning airway management in patients with neurological injury as well as to direct further research into this topic which has significant clinical and patient safety implications.
Highlights
Endotracheal intubation is established as the gold standard for securance of the airway.[1]
Extensive research has been conducted on craniocervical motion caused by a wide range of intubation aids such as various classical laryngoscopes, video laryngoscopes, supraglottic devices and flexible fibre‐optic bronchoscopy (FB)
The assumption of lesser cervical spine movements resulting in avoidance of neurological deterioration is a theoretical premise based on a substantial body of evidence of poor neurological outcomes following intubation
Summary
Endotracheal intubation is established as the gold standard for securance of the airway.[1]. Wong et al compared cervical spine motion during flexible bronchoscopy as compared to Lo‐Pro Glidescope.[22] They demonstrated that the Lo‐Pro Glidescope results in more extension as compared with the fibre‐optic bronchoscope at all cervical spine levels While this was along expected lines, the study was unique for implicating airway manoeuvres performed before FB, especially jaw thrust, with discernible cervical spine movement.[22] The authors noted that the flexible bronchoscopes inability to increase the posterior pharyngeal space during intubation, like a laryngoscope device would, may pose a disadvantage this intubation technique, and the ability of the flexible bronchoscope to produce a small degree of cervical spine motion is a benefit only as long as access to the airway is not hindered. A similar study comparing Macintosh laryngoscope with Bonfils intubation fibrescope showed the stylet in a favourable light.[25]
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