title: Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization.
abstract: OBJECTIVE
  To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts.
  
  
  METHODS
  Prospective, randomized, single-blinded study.
  
  
  METHODS
  Cedars Sinai Medical Center in Los Angeles, CA.
  
  
  METHODS
  One hundred forty patients (American Society of Anaesthesiologists physical status I-III), aged 18 to 80years undergoing elective cervical spine surgery.
  
  
  METHODS
  Patients were prospectively randomized to undergo tracheal intubation using either an FFS (n=70) or the C-MAC video laryngoscope (n=70).
  
  
  METHODS
  After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was assessed at the time of tracheal tube placement using the Cormack-Lehane and percentage of glottic opening scoring systems. In addition, the time required for successful insertion of the tracheal tube, number of intubation attempts to secure the airway, the need for adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded.
  
  
  RESULTS
  The glottic view at the time of intubation did not differ significantly with the 2 devices; however, the C-MAC facilitated more rapid tracheal intubation compared with the FFS (P=.001). The peak heart rate response following insertion of the tracheal tube was also reduced (P=.004) in the C-MAC (vs FFS) group.
  
  
  CONCLUSIONS
  The C-MAC may offer an advantage over the FFS with respect to the time required to obtain glottic view and successful placement of the tracheal tube in patients requiring cervical spine immobilization.
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Roya
authors.initials: R
authors.lastname: Yumul
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Ofelia L
authors.initials: OL
authors.lastname: Elvir-Lazo
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; White Mountain Institute, The Sea Ranch, CA, USA. Electronic address: Paul.White@cshs.org.
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Durra
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Alen
authors.initials: A
authors.lastname: Ternian
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Tamman
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Naruse
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hailu
authors.initials: H
authors.lastname: Ebba
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Taizoon
authors.initials: T
authors.lastname: Yusufali
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wong
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernandez Conte
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; The Mount Sinai Hospital, New York, NY, USA.
authors.forename: Shahbaz
authors.initials: S
authors.lastname: Farnad
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Pham
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes / Q000009:adverse effects; D007828:Laryngoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D055815:Young Adult
keywords: C-MAC video laryngoscope; Cormack-Lehane score; Flexible fiberoptic scope; Manual inline stabilization; Percentage of glottic opening (POGO) score; Tracheal intubation