Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.
ABSTRACT The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.
Ninety patients undergoing anaesthesia who required tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n=30), LMA CTrach (n=30), or AWS (n=30) laryngoscope. All patients were intubated by one of the three anaesthetists familiar with the use of each laryngoscope.
The intubation difficulty scores were significantly higher with the Macintosh laryngoscope and were significantly lower with the AWS compared with the LMA CTrach. All 30 patients were successfully intubated with the Macintosh and the AWS device, compared with 27 patients with the LMA CTrach. The duration of both the first and the successful tracheal intubation attempts was significantly longer with the LMA CTrach compared with the AWS and Macintosh laryngoscopes. A greater number of optimization manoeuvres were required to facilitate tracheal intubation with the LMA CTrach compared with the AWS laryngoscope. The AWS group had a significantly better Cormack and Lehane glottic view obtained at laryngoscopy compared with both other devices.
The AWS laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach, in patients undergoing cervical spine immobilization.
Article: Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation.[show abstract] [hide abstract]
ABSTRACT: For patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar. Anesthesia was induced with propofol, remifentanil, and rocuronium. After a Philadelphia cervical collar applied, patients were randomly assigned to tracheal intubation with an Airtraq (Group A, n = 25) or with conventional laryngoscopy (Group L, n = 25). Measurements included intubation time, success rate of first intubation attempt, number of intubation attempts, and percentage of glottic opening (POGO) score. Mean blood pressure and heart rate were also recorded at baseline, just before and after intubation. The success rate of the first attempt in Group A (96%) was significantly greater than with the Group L (40%). POGO score was significantly greater in Group A (84 ± 20%) than in Group L (6 ± 11%). The duration of successful intubation at first tracheal intubation attempt and hemodynamic changes were not significantly different between the two groups. The Airtraq offers a better laryngeal view and higher success rate at first intubation attempt in patients who are applied with a Philadelphia cervical collar due to suspicion of cervical spine injury.Korean journal of anesthesiology 11/2010; 59(5):314-8.