title: Comparative study of fiberoptic guided versus intubating laryngeal mask airway assisted awake orotracheal intubation in patients with unstable cervical spine.
abstract: BACKGROUND
  A safe airway technique minimizes intubation-associated cervical-spine movement and consequent neurological injury in patients with unstable cervical spine (UCS). Awake fiberoptic-guided intubation (FGI) is preferred in patients with UCS. Alternatively, intubating laryngeal mask airway assisted intubation (ILMA-AI) can be performed both during elective and emergency, requires less expertise and is cost-effective. This study evaluated cervical-spine movement during FGI and ILMA-AI in patients with UCS.
  
  
  METHODS
  This was a parallel-group randomized controlled trial performed at a tertiary neurosciences hospital. Thirty-two patients with UCS scheduled for corrective surgery were allocated equally to receive FGI or ILMA-AI according to centralized computer-generated randomization. Primary outcome measure was cervical-spine movement as assessed using fluoroscopy at C1/2 level during intubation. Secondary outcomes were movement at C2/3 and new-onset motor deficit after intubation.
  
  
  RESULTS
  All the sixteen patients in each group were successfully intubated and their data was analyzed. No significant difference in angles (indicating cervical spine movement) was observed at both C1/2 and C2/3 levels between FGI and ILMA-AI groups at various time points studied (P>0.05). No new-onset motor deficit was observed after intubation in both groups. One patient in FGI group developed desaturation during intubation while four patients in ILMA-AI group developed postoperative sore-throat.
  
  
  CONCLUSIONS
  Similar degree of angulations was observed at various time-points during awake FGI and awake ILMA-AI at C1/2 and C2/3 spinal levels in patients with UCS. No patient developed new-onset motor deficits. ILMA can serve as a suitable alternative to fiberoptic-scope for awake intubation in cervical-spine instability.
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, India.
authors.forename: Tanmay
authors.initials: T
authors.lastname: Jadhav
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, India - drsri23@rediffmail.com.
authors.forename: Kamath
authors.initials: K
authors.lastname: Sriganesh
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, India.
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, India.
authors.forename: Dhritiman
authors.initials: D
authors.lastname: Chakrabarti
mesh_terms: D000328:Adult; D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D007593:Joint Instability / Q000209:etiology; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D014851:Wakefulness