A Methodology to Evaluate Motion of the Unstable Spine During Intubation Techniques

Donaldson, William F.; Towers, Jeffrey D.; Doctor, Allan; Brand, Asher; Donaldson, Valerie P.

doi:10.1097/00007632-199310001-00015

Cited by 69 publications

(18 citation statements)

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“…Manual in-line stabilization has been shown to reduce the range of motion occurring during tracheal intubation. [23][24][25] In contrast, other studies have shown that MILS may actually increase the range of motion of the cervical spine during direct laryngoscopy. 26 However, these studies used volunteers with an intact spine or cadaver models with surgically-induced spinal lesions.…”

Section: Discussionmentioning

confidence: 89%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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Section: Discussionmentioning

confidence: 89%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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“…22,23 The intimation that interventions designed to minimize the risk of neurologic deterioration may be more perilous than previously thought has brought into question the relative safety of many procedures used in the prehospital management of spine-injured patients. As a result, researchers [7][8][9][10][11][12][24][25][26][27][28][29][30][31][32][33][34] have expressed considerable interest in assessing the effectiveness of these procedures, which include airway management protocols, spinal stabilization strategies, procedures for removing protective sporting equipment, and spine-board transfer techniques.…”

Section: Discussionmentioning

confidence: 99%

“…An examination of those studies [7][8][9][10][11][12][24][25][26][27][28][29][30][31][32][33][34] evaluating the various interventions performed in the prehospital setting revealed that some spinal motion is inevitable. Although some authors 35,36 believe that the motion generated by practitioners is insufficient in both magnitude and duration to produce adverse neurologic effects, a few reports 37,38 indicate otherwise.…”

Section: Discussionmentioning

confidence: 99%

The 6-Plus–Person Lift Transfer Technique Compared With Other Methods of Spine Boarding

Rossi

Horodyski

Conrad

et al. 2008

Journal of Athletic Training

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NYContext: To achieve full spinal immobilization during on-thefield management of an actual or potential spinal injury, rescuers transfer and secure patients to a long spine board. Several techniques can be used to facilitate this patient transfer.Objective: To compare spinal segment motion of cadavers during the execution of the 6-plus-person (6+) lift, lift-and-slide (LS), and logroll (LR) spine-board transfer techniques.Design: Crossover study. Setting: Laboratory.Patients or Other Participants: Eight medical professionals (1 woman, 7 men) with 5 to 32 years of experience were enlisted to help carry out the transfer techniques. In addition, test conditions were performed on 5 fresh cadavers (3 males, 2 females) with a mean age of 86.2 6 11.4 years.Main Outcomes Measure(s): Three-dimensional angular and linear motions initially were recorded during execution of transfer techniques, initially using cadavers with intact spines and then after C5-C6 spinal segment destabilization. The mean maximal linear displacement and angular motion obtained and calculated from the 3 trials for each test condition were included in the statistical analysis.Results: Flexion-extension angular motion, as well as anteroposterior and distraction-compression linear motion, did not vary between the LR and either the 6+ lift or LS. Compared with the execution of the 6+ lift and LS, the execution of the LR generated significantly more axial rotation (P 5 .008 and .001, respectively), more lateral flexion (P 5 .005 and .003, respectively), and more medial-lateral translation (P 5 .003 and .004, respectively).Conclusions: A small amount of spinal motion is inevitable when executing spine-board transfer techniques; however, the execution of the 6+ lift or LS appears to minimize the extent of motion generated across a globally unstable spinal segment.Key Words: prehospital care, spine injuries, spinal immobilization, logroll transfer technique, lift-and-slide transfer technique Key Points N The 6-plus-person lift and lift-and-slide transfer techniques appeared to minimize the motion generated across an unstable spinal segment.N Significantly more lateral flexion and axial rotation was generated with the logroll maneuver than with the lift-and-slide and 6-plus-person lift techniques.

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“…Many different techniques have been investigated, including awake blind nasal, oral, or fibreoptic tracheal intubation [2,3], direct laryngoscopy with head and neck stabilisation [4], cricothyroidotomy, indirect laryngoscopy with the Bullard laryngoscope [5], the Combitubee first described by Frass et al [6], and blind oral intubation via the Augustine Guidee [7]. There are two main risks of intubating patients with cervical spine injuries: (1) prolongation of intubation and the subsequent risk of vomiting and aspiration in the usually nonfasted emergency patient, and (2) the hazard of cervical spine excursion during intubation, especially within the functional unit of the occiput-C 3 , or defensive cervical spine movement in the sedated patient, with the risk of additional cervical spine and neurological damage [8]. Clinical experiences in intubating patients with cervical spine injuries via the intubating laryngeal mask (ILM, Fastrache) [9], encouraged us to undertake a prospective, randomised controlled study to compare upper cervical spine excursion during oral tracheal intubation using direct laryngoscopy with that during intubation via the ILM (Fastrache).…”

mentioning

confidence: 99%

Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

Waltl¹,

Melischek²,

Schuschnig³

et al. 2001

Anaesthesia

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SummaryUntil recently, the most appropriate technique of intubating a patient with a cervical spine injury has been the subject of debate. Tracheal intubation by means of the intubating laryngeal mask (Fastrache), a modified conventional laryngeal mask airway, seems to require less neck manipulation. The aim of this study was to compare the excursion of the upper cervical spine during tracheal intubation using direct laryngoscopy with that during intubation via the laryngeal mask (Fastrache), by examination of lateral cervical spine radiographs in healthy young patients. The intubating laryngeal mask (Fastrache) caused less extension (at C 122 and C 223 ) than intubation by direct laryngoscopy. Direct laryngoscopy is still the fastest method to secure an airway provided no intubating difficulties are present. However, in trauma patients requiring rapid sequence induction and in whom cervical spine movement is limited or undesirable, the intubating laryngeal mask (Fastrache) is a safe and fast method by which to secure the airway.

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A Methodology to Evaluate Motion of the Unstable Spine During Intubation Techniques

Cited by 69 publications

References 0 publications

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

The 6-Plus–Person Lift Transfer Technique Compared With Other Methods of Spine Boarding

Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

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