Cervical spine movements during laryngoscopyComparison of the Macintosh and McCoy laryngoscope blades

Macintyre, P. A.; McLeod, André; Hurley, R. Morrison; Peacock, C.

doi:10.1046/j.1365-2044.1999.00804.x

Cited by 36 publications

(29 citation statements)

References 28 publications

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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%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 99%

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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“…17 Macintyre et al observed no limitation of cervical movements during intubation in patients wearing a collar. 18 Moreover, in a cadaveric study, it was found that a collar can actually increase cervical motion by acting as a lever. 19 Despite this, probably for lack of a convenient and suitable alternative, semi-rigid collars are still commonly used.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Intubating Laryngeal Mask Airway (ILMA) as an intubation conduit in patients with a cervical collar simulating fixed cervical spine

Saini

Bala

Singh

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Cervical spine immobilisation with a semi-rigid cervical collar imposes difficulty in tracheal intubation. There is increasing use of the Intubating Laryngeal Mask Airway (LMA-Fastrach TM ) for intubation in patients with difficult airways. The present study was conducted to assess its potential role for tracheal intubation in simulated fixed cervical spine patients. Method: After obtaining approval from the ethics committee and patients' consent, this observational study was performed on 35 adult patients of either sex of ASA physical status I and II scheduled to undergo surgery under general anaesthesia requiring tracheal intubation. A two-piece semi-rigid cervical collar of appropriate size was positioned around the neck of patients. A standard anaesthesia protocol comprising glycopyrrolate, propofol and vecuronium was used for induction of anaesthesia. ILMA placement and blind tracheal intubation through this was attempted by using dedicated silicone tube provided with the ILMA set. Success rate, number of attempts required, time taken, difficulties encountered and any complication that occurred were noted. Anaesthesia was maintained with isoflurane in oxygen and nitrous oxide, pethidine and vecuronium. Following completion of surgery, neuromuscular blockade was reversed with glycopyrrolate and neostigmine. Results: The overall success rate was 85.7% and the success rate for ILMA placement at first attempt was 57.1%. Tracheal intubation was successful at first attempt in 70.5% of patients. The time taken for ILMA placement and tracheal intubation through this was 31.76 ± 9.74 and 34.04 ± 12.68 seconds respectively. Decreased mouth opening due to presence of the collar led to difficulty in ILMA placement. Conclusions: Blind tracheal intubation through ILMA is a possible option for airway management in patients with a semi-rigid cervical collar.

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“…Direct laryngoscopic intubation under manual in-line neck stabilization of the head and neck and cricoid pressure is an often performed and a well accepted approach in such situations. 5,19,20 However, direct laryngoscopy can be more difficult under MAIS and forced laryngeal or cricoid pressure can cause movements of the cervical spine during intubation. [6][7][8] If difficulties with direct visualization of the vocal cords occur, anesthesiologists often rely on blind tracheal intubation using a styletted ET or a gum-elastic bougie.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, head extension should be avoided by having an assistant hold the head in the neutral position during laryngoscopy. 5 However, manual inline stabilization of the head and neck (MAIS) can make direct laryngoscopic intubation difficult. 6 -8 A new device to facilitate this task is the angulated videointubation laryngoscope (AVIL).…”

mentioning

confidence: 99%

Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope

Dullenkopf

Holzmann

Feurer

et al. 2002

Can J Anesth/J Can Anesth

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Purpose: There are a number of syndromes with proven or suspected instability of the cervical spine especially in pediatric patients. It is a challenge for the anesthesiologist to intubate these patients with as little movement of the cervical spine as possible. A new device to facilitate this task is the angulated video-intubation laryngoscope (AVIL).Clinical features: The AVIL is a curved endoscopic intubation laryngoscope with angulated distal tip. The video-view from the distal blade tip improves glottic visualization during difficult direct laryngoscopy. We report three sisters with Morquio syndrome scheduled for otorhinolaryngology surgery the same day. Two of them had radiologically suspected cervical spine instability. Tracheal intubation was planned with careful direct laryngoscopy under manual in-line stabilization of the neck and head by an assistant. Direct visualization of the larynx using a Miller blade No. 2 was impaired in two of the three children in whom the cervical spine was immobilized. They were both successfully intubated under endoscopic control using the AVIL. Conclusion:The AVIL may become a helpful device to aid endotracheal intubation in patients when cervical spine immobilization impairs direct laryngoscopy.

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Cervical spine movements during laryngoscopyComparison of the Macintosh and McCoy laryngoscope blades

Cited by 36 publications

References 28 publications

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

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

Evaluation of the Intubating Laryngeal Mask Airway (ILMA) as an intubation conduit in patients with a cervical collar simulating fixed cervical spine

Tracheal intubation in children with Morquio syndrome using the angulated video-intubation laryngoscope

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