Abstract
Background and Aims : Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods : Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. Conclusion: The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.
Highlights
Use of video laryngoscopes in the management of difficult airway is on the surge as their role has been redefined in recently updated difficult airway society algorithm.1In cervical spine (C-spine) injury, the standard positioning and intubation technique for direct laryngoscopy cannot be employed in order to minimize the cervical spine injury.[2,3,4] In our study, we are simulating a restricted neck movement by applying manual in line axial stabilization [MIAS] maneuver in patients requiring general anaesthesia with endotracheal intubation who have neither difficult airway nor Cspine injuries
The present study shows good glottis view with C-MAC; Intubation Difficulty Scale score (IDS) score is similar to conventional Macintosh laryngoscopy
Our study partially supports this study as we found better CL grades but we were unable to find any statistical significance in the IDS score
Summary
Use of video laryngoscopes in the management of difficult airway is on the surge as their role has been redefined in recently updated difficult airway society algorithm.1In cervical spine (C-spine) injury, the standard positioning and intubation technique for direct laryngoscopy cannot be employed in order to minimize the cervical spine injury.[2,3,4] In our study, we are simulating a restricted neck movement by applying manual in line axial stabilization [MIAS] maneuver in patients requiring general anaesthesia with endotracheal intubation who have neither difficult airway nor Cspine injuries. Endotracheal intubation in patients with cervical spine injury can be challenging in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm
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