Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie.
The conditions for emergency tracheal intubation of patients with cervical spine injury were simulated in 157 patients during induction of anaesthesia for routine surgery. The view of the larynx obtained during laryngoscopy with the head in the optimum intubating position was compared with that obtained when manual in-line stabilisation of the cervical spine and cricoid pressure were used. During laryngoscopy with cervical stabilisation, the view of the larynx was reduced in 45% of patients, and in 22% of patients nothing was visible beyond the epiglottis. To assess the ease of intubation with the neck stabilised and with cricoid pressure applied, patients were randomised to either direct visual intubation (n = 79), or intubation aided by a gum elastic bougie (n = 78). The median time taken for visual intubation was 20 s, but in six patients intubation took over 45 s. In addition, five patients in this group could not be directly intubated. Using the gum elastic bougie all patients, including the failures from the visual group, were intubated within 45 s (median 25 s). We recommend the gum elastic bougie as an aid to intubating the patient with suspected cervical spine injury, particularly when the glottis is not immediately visible.
Nolan
J P
JP
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath.
Wilson
M E
ME
D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D011187:Posture; D013997:Time Factors