title: Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq(®) , Macintosh and McCoy laryngoscopes.
abstract: Concern that laryngoscopy and intubation might create or exacerbate a spinal cord injury has generated extensive research into cervical spinal movement during laryngoscopy. We performed a randomised trial on six cadavers, using three different laryngoscopes, before and after creating a type-2 odontoid peg fracture. Our primary outcome measure was the change in the space available for the spinal cord at the C1/2 segment measured by cinefluoroscopy. Tracheal intubation was performed using a minimal view of the glottis, a bougie, and manual in-line stabilisation. In a cadaveric model of type-2 odontoid fracture, the space available for the cord was preserved in maximum flexion and extension, and changed little on laryngoscopy and intubation.
authors.affiliation: Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: McCahon
authors.forename: D A
authors.initials: DA
authors.lastname: Evans
authors.forename: R W
authors.initials: RW
authors.lastname: Kerslake
authors.forename: S H
authors.initials: SH
authors.lastname: McClelland
authors.forename: J G
authors.initials: JG
authors.lastname: Hardman
authors.forename: A M
authors.initials: AM
authors.lastname: Norris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000503:physiopathology*; D002102:Cadaver; D002574:Cervical Vertebrae / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D019416:Head Movements / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy; D009068:Movement / Q000502:physiology*; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*