Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial.

Yoon Jung Kim,Hyun-Kyu Yoon,Hyung-Chul Lee,Hyongmin Oh,Chahnmee Hur,Hee-Pyoung Park

doi:10.3390/jcm10132931

Yoon Jung Kim, Hyun-Kyu Yoon + Show 4 more

Open Access

https://doi.org/10.3390/jcm10132931

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Abstract

We hypothesized that external laryngeal manipulation would reduce cervical spine motion during video laryngoscopic intubation under manual in-line stabilization by reducing the force required to lift the videolaryngoscope. In this randomized crossover trial, 27 neurointerventional patients underwent two consecutive videolaryngoscopic intubation attempts under manual in-line stabilization. External laryngeal manipulation was applied to all patients in either the first or second attempt. In the second attempt, we tried to reproduce the percentage of glottic opening score obtained in the first attempt. Primary outcomes were cervical spine motion during intubation at the occiput-C1, C1–C2, and C2–C5 segments. The intubation success rate (secondary outcome measure) was recorded. Cervical spine motion during intubation at the occiput-C1 segment was significantly smaller with than without external laryngeal manipulation (7.4° ± 4.6° vs. 11.5° ± 4.8°, mean difference −4.1° (98.33% confidence interval −5.8° to −2.3°), p < 0.001), showing a reduction of 35.7%. Cervical spine motion during intubation at the other segments was not significantly different with versus without external laryngeal manipulation. All intubations were achieved successfully regardless of the application of external laryngeal manipulation. External laryngeal manipulation is a useful method to reduce upper cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.

Highlights

Excessive cervical spine motion during intubation can cause adverse events, such as spinal cord injury, in patients with cervical spine instability [1,2]
This is because the force required to lift the videolaryngoscope causes cervical spine motion during intubation, it is smaller than the force required to lift the direct laryngoscope [19,20,21,22]
When External laryngeal manipulation (ELM) was applied during videolaryngoscopic intubation under manual in-line stabilization (MILS), cervical spine motion was significantly reduced by 36% at the occiput-C1 segment

Summary

Introduction

Excessive cervical spine motion during intubation can cause adverse events, such as spinal cord injury, in patients with cervical spine instability [1,2]. It is inevitable that some degree of cervical spine motion will occur during videolaryngoscopic intubation even under cervical immobilization [6,8,9,11,14,15,16,17,18]. This is because the force required to lift the videolaryngoscope causes cervical spine motion during intubation, it is smaller than the force required to lift the direct laryngoscope [19,20,21,22]

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