A comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2.
BACKGROUND
The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain.


METHODS
To examine the potential for mechanical disruption during endotracheal intubation in cadavers with unstable cervical spines, we performed a prospective observational cohort study with 3 cadaver subjects. We created an unstable, type II odontoid fracture with global ligamentous instability at C1-2 in lightly embalmed cadavers, followed by repetitive intubations with 4 different airway devices (Airtraq laryngoscope, Lightwand, intubating laryngeal mask airway [LMA], and Macintosh laryngoscope) while manual in-line stabilization was applied. Motion analysis data were collected using an electromagnetic device to assess the degree of angular movement in 3 axes (flexion-extension, axial rotation, and lateral bending) during the intubation trials with each device. Intubation was performed by either an emergency medical technician or attending anesthesiologist.


RESULTS
Overall, 153 intubations were recorded with the 4 devices. The Lightwand technique resulted in significantly less flexion-extension and axial rotation at C1-2 than with the intubating LMA (mean difference in flexion-extension 3.2° [95% confidence interval {CI}, 0.9°-5.5°], P = 0.003; mean difference in axial rotation 1.6° [95% CI, 0.3°-2.8°], P = 0.01) and Macintosh laryngoscope (mean difference in flexion-extension 3.1° [95% CI, 0.8°-5.4°], P = 0.005; mean difference in axial rotation 1.4° [95% CI 0.1°-2.6°], P = 0.03).


CONCLUSIONS
In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.
Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, 1600 S.W. Archer Rd., Gainesville, FL 32610-0254, USA. awendling@anest.ufl.edu
Adam L
AL
Wendling
Patrick J
PJ
Tighe
Bryan P
BP
Conrad
Tezcan Ozrazgat
TO
Baslanti
Marybeth
M
Horodyski
Glenn R
GR
Rechtine
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D015331:Cohort Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D007593:Joint Instability / Q000150:complications; D017214:Laryngeal Masks / Q000592:standards; D008022:Ligaments / Q000293:injuries*; D009809:Odontoid Process / Q000293:injuries*; D011446:Prospective Studies; D016103:Spinal Fractures / Q000150:complications