Endotracheal Intubation in Patients with Cervical Spine Immobilization

Maharaj, Chris; Buckley, Elma; Harte, B. H.; Laffey, John G.

doi:10.1097/01.anes.0000267529.71756.f0

Cited by 181 publications

(134 citation statements)

References 30 publications

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“…After obtaining approval by the Galway University Hospitals Research Ethics Committee (Galway, Ireland), we re-analysed data from six previously published clinical trials from our group that compared the Pentax AWS, Airtraq and Glidescope laryngoscopes with the Macintosh laryngoscope [14,16,17,[20][21][22]. The analysis was restricted to studies from our group in order to ensure standardisation of data collection.…”

Section: Methodsmentioning

confidence: 99%

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

McElwain¹,

Simpkin

Laffey³

2011

Anaesthesia

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SummaryThe purpose of this study was to determine whether the Intubation Difficulty Scale is meaningful when used with indirect laryngoscopes. Data were analysed from previously published clinical trials from our group that compared the indirect laryngoscopes with the Macintosh laryngoscope. For each laryngoscope type, the Intubation Difficulty Scale score obtained for each tracheal intubation was correlated with data for duration of the intubation attempt and with the user rated difficulty of the intubation attempt. The strengths of the correlations between these indices were then compared for tracheas intubated with the Macintosh vs the indirect laryngoscopes. The Intubation Difficulty Scale performed well when compared with data for duration and user rated difficulty of the intubation attempts for the both direct and indirect laryngoscopy. However, the correlation between the Intubation Difficulty Scale score and both user rated difficulty (p = 0.001) and the duration of tracheal intubation (p = 0.003) were significantly stronger for the Macintosh laryngoscope compared with the indirect laryngoscopes. In contrast, the correlation between user rated difficulty scores and the data for duration of tracheal intubation was not different between the device types. The Intubation Difficulty Scale performs less well with indirect laryngoscopes than with the Macintosh laryngoscope. These findings suggest the need for caution with the use of this score with indirect laryngoscopes. Difficult tracheal intubation remains a major source of morbidity and mortality, in the operating theatre [1][2][3] and in the emergency setting [4,5]. Difficult or failed tracheal intubation is an important cause of anaesthetic death and brain damage [6][7][8][9][10][11]. These issues have stimulated the development of 'indirect' laryngoscopes, with the aim of reducing the difficulty obtaining a laryngeal view. Many such devices now exist on the market, including the Glidescope [12, 13], Airtraq [14], Pentax Airway Scope (AWS) [12,15,16], TruView [12,16], and LMA C-Trach [17]. One difficulty encountered investigating the utility of these devices is the lack of a gold standard descriptor for intubation difficulty. While indices such as the duration of tracheal intubation attempts and user rated scores of the difficulty of laryngoscopy and intubation are useful, they do not provide a complete picture. A more objective scoring system might serve as a reproducible quantitative means of overcoming some of these limitations.Adnet et al. proposed the Intubation Difficulty Scale (IDS), which incorporates seven parameters (see Appendix 1) [18], for use when describing direct laryngoscopy and intubation. More recently, the IDS has been used to describe difficulty of laryngoscopy and tracheal intubation with indirect laryngoscopes in multiple studies by our group [13,16,17] and others [15,19]. However, the validity of the IDS when used with indirect laryngoscopes has not been evaluated.

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Section: Methodsmentioning

confidence: 99%

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

McElwain¹,

Simpkin

Laffey³

2011

Anaesthesia

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show abstract

“…[10] A study of anesthetized patients with manual inline axial stabilization to limit cervical spine mobility showed improved glottic view and reduced duration of intubation attempts when comparing Airtraq OL and direct laryngoscopy with a Macintosh blade. [11] In fact, clinical situations with limited cervical spine mobility, while problematic for direct laryngoscopy, do not adversely influence Airtraq OL as optimal patient position for intubation using this device was found to be inline head and neck position. [12] No studies compared cervical spine motion using Storz VL instead of direct laryngoscopy.…”

Section: Discussionmentioning

confidence: 95%

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model

Wadman¹,

Dierks²,

Branecki³

et al. 2011

World Journal of Emergency Medicine

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“…9 Maharaj CH et al studies have demonstrated that the Airtraq reduces the difficulty of tracheal intubation in patients undergoing cervical spine immobilisation with MILS when compared with the Macintosh laryngoscope. 11 Koh et al reported higher success rate of intubation with Airtraq in patients with cervical immobilisation with collar. 12 Arslan et al evaluated the effectiveness of the Airtraq in patients with simulated cervical spine injury after application of a rigid cervical collar.…”

Section: Discussionmentioning

confidence: 98%

A comparative study of endotracheal intubation as per intubation difficulty score, using Airtraq and McCoy laryngoscopes with manual-in-line axial stabilization of cervical spine in adult patients

2016

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Endotracheal Intubation in Patients with Cervical Spine Immobilization

Abstract: These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in patients with cervical spine immobilization.

Cited by 181 publications

References 30 publications

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model

A comparative study of endotracheal intubation as per intubation difficulty score, using Airtraq and McCoy laryngoscopes with manual-in-line axial stabilization of cervical spine in adult patients

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