Intubation with King Vision® video laryngoscope and Macintosh laryngoscope in cervical spine injured: A randomized controlled trial

Abstract

Background: Intubation of trachea with conventional laryngoscopy requires alignment of the oropharyngeal–laryngeal axis in a straight line. This causes significant movement of the cervical spine, which in case of any previous injury to the spinal cord, may be further damaged due to impingement of the cord between the broken vertebrae. King Vision® video laryngoscope due to its particular J shape and a channel to carry the tube, causes less movement of the spine and hence provides better and safer intubation conditions in patients who have cervical injury. Methods: The study was conducted in a tertiary-level orthopedic and spine center. It was a single-blind randomized control study. After obtaining permission from Hospital Ethics Committee and patient's consent, 60 patients of cervical spine injury of American Society of Anesthesiologists I-III, and normal airway anatomy, were assessed for ease and safety of intubation by – (a) King Vision® video laryngoscope and (b) Macintosh laryngoscope. The primary criteria were Intubation Difficulty Scale (IDS), while the secondary criteria were duration of intubation, heart rate, and mean arterial pressure. Results: Results were analyzed by Chi-square, Mann–Whitney, and Student t-test using SPSS software. P value was 0.05. The mean IDS in King Vision® video laryngoscope group was significantly less than Macintosh group. However, there was no statistical difference in duration of intubation and hemodynamic parameters. Conclusions: Intubation in cervical spine injury patients with neck immobilization is easier with King Vision® video laryngoscope, but duration of intubation, complication rate, and hemodynamic parameters remain the same as compared with Macintosh laryngoscope.