Intubation Biomechanics

Hindman, Bradley J.; From, Robert P.; Fontes, Ricardo B. V.; Traynelis, Vincent C.; Todd, Michael M.; Zimmerman, M. Bridget; Puttlitz, Christian M.; Santoni, Brandon G.

doi:10.1097/aln.0000000000000830

Cited by 28 publications

(14 citation statements)

References 61 publications

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“…[ 1 ] A plethora of research on different intubation techniques in actual or simulated CSI has been published. [ 2 3 4 5 ] However, current studies largely focus on surrogate outcomes, such as intubation success rate or degree of cervical spine movement versus patient-centric outcomes such as intubation-associated neurological deficits. Further, there are no guidelines provided by societies such as the Difficult Airway Society[ 6 ] or American Society of Anesthesiologists[ 7 ] which address special concerns regarding intubation in patients with CSI.…”

Section: Introductionmentioning

confidence: 99%

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

et al. 2018

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Background and Aims:There is a paucity of clinical practice guidelines for the ideal approach to airway management in patients with cervical spine instability (CSI). The aim of this survey was to evaluate preferences, perceptions and practices regarding airway management in patients with CSI among neuroanaesthesiologists practicing in India.Methods:A 25-item questionnaire was circulated for cross-sectional survey to 378 members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) by E-mail. We sent four reminders and again submitted our survey to non-responders during the 2017 annual ISNACC meeting. Apart from demographic information, the survey captured preferred methods of intubation and airway management for patients with CSI and their justification. Regression analysis was used to identify factors associated with the use of indirect technique for intubation.Results:Only 122 out of the 378 anaesthesiologists responded to our survey. Most respondents were senior consultants, working in training hospitals, and performed ≥25 intubations per year for CSI patients. The majority of neuroanaesthesiologists (78.7%; n = 96) preferred indirect techniques for elective intubation. However, 45 anaesthesiologists (36.9%) preferred indirect techniques for emergency intubation. In an adjusted analysis, preference for patients to be conscious during intubation was significantly associated with the use of indirect techniques (odds ratio = 3.79; confidence interval = 1.52–9.49, P < 0.01).Conclusions:Among ISNACC members, indirect techniques are preferred for elective intubation of patients with CSI, while direct laryngoscopy is preferred for emergency intubation.

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Section: Introductionmentioning

confidence: 99%

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

et al. 2018

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“…Also, another previous study showed a similar result on cervical spine motion at the C1-C2 segment (the median value: 6.0°) when the Airway Scope videolaryngoscope was used for intubation [ 3 ]. By contrast, a previous study conducted by Dr. Hindman and coworkers showed that the cervical spine motion at the C1-C2 segment was 2.3° during Airtraq videolaryngoscopic intubation [ 20 ]. Taken together, although the cervical spine motion at the C1-C2 segment depends on a videolaryngoscope used for intubation, it seems to be similar during intubation with various videolaryngoscopes.…”

Section: Discussionmentioning

confidence: 88%

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Paik

Park

2020

BMC Anesthesiol

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Background: Maintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization. Methods: In this randomized crossover study, the cervical spine angle was measured at the occiput-C1, C1-C2, and C2-C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation. Results: The cervical spine motion at the occiput-C1 segment was measured at 12.1 ± 4.2°and 6.8 ± 5.0°during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, − 5.3; 98.33% CI: − 8.8 to − 1.8; p = 0.001). However, there was no significant difference between the two intubation devices at the C1-C2 segment (− 0.6; 98.33% CI: − 3.4 to 2.2; p = 0.639) or C2-C5 segment (0.2; 98.33% CI: − 6.0 to 6.4; p = 0.929). Conclusions: The C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization. Trial registration: This study was registered at ClinicalTrials.gov on June 26, 2018 (NCT03567902).

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“…Recent studies of cadaver biomechanics reported a non-significant difference in cervical spine motion between intact fresh cadavers and living patients in both stable and unstable cervical spine [ 37 – 40 ]. Thus, results of fresh cadaver studies seem to be of some relevance to the clinical situation.…”

Section: Discussionmentioning

confidence: 99%

“…Fresh cadavers were frozen shortly after mortem and thawed to room temperature for simulating the elasticity of joints and soft tissues in living situation. Recent studies of cadaver biomechanics postulate no significant differences between fresh cadavers and patients towards cervical spine motion [ 37 – 40 ]. Cadavers with a postmortem interval of less than 5 days were eligible for the study.…”

Section: Methodsmentioning

confidence: 99%

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Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

et al. 2018

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BackgroundUnstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown.The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction.Methods and findingsLigamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system.In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure.ConclusionThe current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.

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Intubation Biomechanics

Cited by 28 publications

References 61 publications

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

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