title: Comparison of intubation times using a manikin with an immobilized cervical spine: Macintosh laryngoscope vs. GlideScope vs. fiberoptic bronchoscope.
abstract: OBJECTIVE
  Airway management in patients with suspected cervical spine injury is classified as a "difficult airway." The best device for managing difficult airways is not known. Therefore, we conducted an intubation study simulating patients with cervical spine injury using three devices: a conventional Macintosh laryngoscope, a video laryngoscope (GlideScope), and a fiberoptic bronchoscope (MAF-TM). Success rates, intubation time, and complication rates were compared.
  
  
  METHODS
  Nine physician experts in airway management participated in this study. Cervical immobilization was used to simulate a difficult airway. Each participant performed intubation using airway devices in a randomly chosen order. We measured the time to vocal cord visualization, time to endotracheal tube insertion, and total tracheal intubation time. Success rates and dental injury rates were compared between devices.
  
  
  RESULTS
  Total tracheal intubation time using the Macintosh laryngoscope, GlideScope, and fiberoptic bronchoscope was 13.3 (range, 11.1 to 20.1), 14.9 (range, 12.7 to 22.3), and 19.4 seconds (range, 14.1 to 32.5), respectively. Total tracheal intubation time differed significantly among the devices (P=0.009). Success rates for the Macintosh laryngoscope, GlideScope, and fiberoptic bronchoscope were 98%, 96%, and 100%, respectively, and dental injury rates were 5%, 19%, and 0%, respectively.
  
  
  CONCLUSIONS
  The fiberoptic bronchoscope required longer intubation times than the other devices. However, this device had the best success rate with the least incidence of dental injury.
authors.affiliation: Department of Emergency Medicine, National Medical Center, Seoul, Korea.
authors.forename: Jung-In
authors.initials: JI
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Sang Ook
authors.initials: SO
authors.lastname: Ha
authors.affiliation: Department of Anesthesia, National Medical Center, Seoul, Korea.
authors.forename: Min Seok
authors.initials: MS
authors.lastname: Koo
authors.affiliation: Department of Anesthesia, National Medical Center, Seoul, Korea.
authors.forename: Miyoung
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Department of Anesthesia, National Medical Center, Seoul, Korea.
authors.forename: Jieun
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Jeon
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
authors.forename: So Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Sangwoo
authors.initials: S
authors.lastname: Shim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Youjin
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, National Medical Center, Seoul, Korea.
authors.forename: Taejin
authors.initials: T
authors.lastname: Park
keywords: Airway management; Bronchoscope; Head trauma