Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope.
The question of which is the optimum technique to intubate the trachea in a patient who may have a cervical(C)-spine injury remains unresolved. We compared, using fluoroscopic video, C-spine motion during intubation for Macintosh 3 blade, GlideScope, and Intubating Lighted Stylet, popularly known as the Lightwand or Trachlight. Thirty-six healthy patients were randomized to participate in a crossover trial of either Lightwand or GlideScope to Macintosh laryngoscopy, with in-line stabilization. C-spine motion was examined at the Occiput-C1 junction, C1-2 junction, C2-5 motion segment, and C5-thoracic motion segment during manual ventilation via bag-mask, laryngoscopy, and intubation. Time to intubate was also measured. C-spine motion during bag-mask ventilation was 82% less at the four motion segments studied than during Macintosh laryngoscopy (P < 0.001). C-spine motion using the Lightwand was less than during Macintosh laryngoscopy, averaging 57% less at the four motion segments studied (P < 0.03). There was no significant difference in time to intubate between the Lightwand and the Macintosh blade. C-spine motion was reduced 50% at the C2-5 segment using the GlideScope (P < 0.04) but unchanged at the other segments. Laryngoscopy with GlideScope took 62% longer than with the Macintosh blade (P < 0.01). Thus, the Lightwand (Intubating Lighted Stylet) is associated with reduced C-spine movement during endotracheal intubation compared with the Macintosh laryngoscope.
Turkstra
Timothy P
TP
Department of *Anesthesia and Perioperative Medicine and †Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, Canada.
Craen
Rosemary A
RA
Pelz
David M
DM
Gelb
Adrian W
AW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D002574:Cervical Vertebrae; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D008297:Male; D008875:Middle Aged; D009068:Movement; D011446:Prospective Studies; D011859:Radiography; D012121:Respiration, Artificial; D013131:Spine / Q000000981:diagnostic imaging* / Q000502:physiology*