title: Cervical spine motion during flexible bronchoscopy compared with the Lo-Pro GlideScope.
abstract: BACKGROUND
  The most appropriate device for tracheal intubation in patients with potential cervical spine injury remains controversial. We hypothesized that the Lo-Pro GlideScope (LP-G) videolaryngoscope would not cause significantly greater cervical spine movement than fibreoptic bronchoscopy even in the non-immobilized spine.
  
  
  METHODS
  Twenty-eight healthy adults requiring intubation for radiographic procedures were randomized to either the LP-G or the flexible bronchoscope (FB) devices. Continuous fluoroscopy was used to assess cervical spine movement during tracheal intubation. The point of maximum movement was compared with baseline for change in angulation between Occiput (Occ)-C1, Occ-C2, Occ-C4, Occ-C5, C1-2, C2-4, and C4-5. Measurements were made by two independent observers. The change in angulation was also measured for tongue pull and jaw thrust, manoeuvres for enlarging the pharyngeal space, before FB intubation.
  
  
  RESULTS
  LP-G resulted in greater cervical extension compared with FB for every angle calculated, statistically significant between Occ-C1 (P<0.05), Occ-C2 (P<0.05), and Occ-C4 (P<0.01). Tongue pull resulted in significantly less cervical spine motion than FB intubation at Occ-C1, Occ-C2, Occ-C4, and Occ-C5 (P<0.05). When jaw thrust was added to tongue pull, there was a tendency for greater movement than FB intubation at Occ-C1, Occ-C2, and Occ-C3. This was statistically significant at Occ-C1 and Occ-C3 (P<0.05) for one of the two observers.
  
  
  CONCLUSIONS
  During intubation under general anaesthesia, LP-G resulted in greater cervical movement than FB when no cervical immobilization was used in adults without cervical disease. Airway manoeuvres performed before FB, especially jaw thrust, also resulted in cervical spine movement.
authors.affiliation: Department of Anaesthesia, Toronto Western Hospital, Canada. danielm.ywong@gmail.com
authors.forename: D M
authors.initials: DM
authors.lastname: Wong
authors.forename: A
authors.initials: A
authors.lastname: Prabhu
authors.forename: S
authors.initials: S
authors.lastname: Chakraborty
authors.forename: G
authors.initials: G
authors.lastname: Tan
authors.forename: E M
authors.initials: EM
authors.lastname: Massicotte
authors.forename: R
authors.initials: R
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods; D002574:Cervical Vertebrae / Q000502:physiology*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D008297:Male; D008875:Middle Aged; D009068:Movement; D015588:Observer Variation; D011446:Prospective Studies; D055815:Young Adult