Evaluation of Tracheal Intubation Difficulty in Patients with Cervical Spine Immobilization

Smith, Charles E.; Pinchak, Anna B.; Sidhu, Tejbir S.; Radesic, Brian P.; Pinchak, Alfred C.; Hagen, Joan F.

doi:10.1097/00000542-199911000-00015

Cited by 78 publications

(35 citation statements)

References 20 publications

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“…12 Using manual in-line stabilization of the cervical spine, difficult laryngoscopy with a Macintosh blade occurred in only 16-33% of patients. 13,14 This improvement in intubating conditions can be attributed to almost unrestricted mouth opening during manual in-line stabilization, compared to a substantively diminished inter-incisor distance when a rigid cervical collar is used. Therefore, manual in-line stabilization of the cervical spine simulates a difficult airway to a lesser extent than a rigid immobilization collar.…”

Section: Discussionmentioning

confidence: 99%

Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway

Byhahn

Nemetz

Breitkreutz

et al. 2008

Can J Anesth/J Can Anesth

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Background:The Bonfils intubation fibrescope (BIF), a rigid, straight and reusable fibreoptic device, is being used increasingly to facilitate endotracheal intubation after direct laryngoscopy has failed. We tested the hypothesis that, with the BIF compared to direct laryngoscopy, the rate of failed endotracheal intubation could be reduced in patients with a difficult airway, simulated by means of a rigid cervical immobilization collar.Methods: Seventy-six adults undergoing elective gynecological surgery under general anesthesia were randomly assigned to have endotracheal intubation, facilitated with either a standard size 3 Macintosh laryngoscope blade, or the BIF. A rigid cervical immobilization collar was used to simulate a difficult airway, by reducing mouth opening and limiting neck extension. If endotracheal intubation could not be achieved within two attempts, the cervical collar was removed, and direct laryngoscopy was performed thereafter, using a Macintosh blade in all subjects. The success rate of endotracheal tube placement was the primary outcome variable. Results: Patient characteristics were similar in the two groups. After neck immobilization, the inter-incisor distance was reduced to 2.6 ± 0.7 cm (Macintosh) and 2.6 ± 0.8 cm (BIF). Tube placement was successful in 15/38 (39.5%) patients with a Macintosh blade, and in 31/38 patients with the BIF (81.6%; P = 0.0003). Time required for tube placement was 53 ± 22 sec (Macintosh) and 64 ± 24 sec (BIF; P = 0.15). Conclusion:The Bonfils intubation fibrescope is a more effective intubating device for patients with immobilized cervical spine and significantly limited inter-incisor distance, when compared to direct laryngoscopy.

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Section: Discussionmentioning

confidence: 99%

Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway

Byhahn

Nemetz

Breitkreutz

et al. 2008

Can J Anesth/J Can Anesth

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“…Since MILS does limit movement of the head during tracheal intubation, it impairs visualization of the larynx, as consistently shown by a reduction in the incidence of Cormack and Lehane's grade 1 laryngeal visualization and an increased incidence of grades 2, 3 and 4. [3][4][5] However, evaluation of laryngoscopic view with the Cormack and Lehane scale is known to have a poor inter-physician reliability, 6 and it remains a surrogate marker of the difficulty of endotracheal intubation. Thus, to appropriately appreciate its impact on endotracheal intubation, the effects of MILS should be assessed directly.…”

Section: Résumémentioning

confidence: 99%

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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“…Cervical spine immobilisation reduces the quality of glottis exposure. 7 Manual inline axial stabilization (MILAS) prevents head extension and neck flexion, which are necessary for optimal alignment of the three airway axes and exposure of the vocal cords using direct laryngoscopy techniques. Increased incidence of grade 3 and 4 laryngoscopic views (up to 64%) with conventional laryngoscopy with the use of a rigid collar, tape and sandbags is due to the combination of decreased interincisor distance and cervical spine immobility.…”

Section: Discussionmentioning

confidence: 99%

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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Evaluation of Tracheal Intubation Difficulty in Patients with Cervical Spine Immobilization

Cited by 78 publications

References 20 publications

Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway

Brief report: Tracheal intubation using the Bonfils intubation fibrescope or direct laryngoscopy for patients with a simulated difficult airway

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

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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