Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet vs Macintosh laryngoscope.
OBJECTIVE
The optimal technique to manage the airway in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using fluoroscopic video assessment, C-spine motion during laryngoscopy with a Shikani Optical Stylet (SOS) was compared to C-spine motion during intubation using a Macintosh blade.


METHODS
Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and Shikani laryngoscopy with manual inline stabilization following induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryngoscopy was also measured (duration > 120 sec was deemed a failure of the laryngoscopy technique).


RESULTS
On average, C-spine motion was 52% less (P < 0.02) at three of the motion segments studied, occiput-C1, C2-C5, and C5-thoracic when comparing SOS vs Macintosh laryngoscopy. There was no difference between techniques at the C1-C2 segment. Laryngoscopy with SOS (28 +/- 17 sec) took longer than with Macintosh blade (17 +/- 7 sec), P < 0.01. There were two failures out of 23 using the SOS, vs none with the Macintosh blade.


CONCLUSIONS
For patients in whom C-spine movement is undesirable, use of the SOS may limit neck movement, while modestly increasing the time required to intubate, and/or the risk of procedure failure.
Turkstra
Timothy P
TP
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Room C3-104, London Health Sciences Centre, London, Ontario, Canada. timothy.turkstra@londonhospitals.ca
Pelz
David M
DM
Shaikh
A Allison
AA
Craen
Rosemary A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000502:physiology*; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D013131:Spine / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology*