Tracheal intubation in patients immobilized by a rigid collar: a comparison of GlideScope and an intubating laryngeal mask airway*

Abstract

Background/aim: Intubation must be rapidly performed with the utmost care in cervical trauma patients. We present the first comparison of GlideScope and an intubating laryngeal mask airway (ILMA) regarding insertion and intubation times, intubation success rates, mucosal damage, need for optimization maneuvers, effects on hemodynamic changes, and postoperative minor complications in a simulated cervical injury with a Philadelphia cervical collar. Materials and methods:Ethics committee approval and patient consent were obtained and 94 American Society of Anesthesiology physical status I or II patients were enrolled in this study. Following standard anesthesia monitoring and induction, the Philadelphiatype cervical collar was applied and patients were subsequently intubated with ILMA or GlideScope. Results:The total intubation success rates were similar between the groups (96%). The insertion (14.9 ± 10 s vs. 21.9 ± 6.5 s, respectively; P < 0.001) and intubation (43.5 ± 13 s vs. 48.4 ± 11 s; P = 0.02) times for ILMA were longer than for GlideScope. The total intubation times for ILMA were longer than the intubation time for GlideScope (43.5 ± 13 s vs. 85.6 ± 13 s; P < 0.001). The mucosal damage was higher in the ILMA group (P = 0.04). The two airway devices increased the heart rate and mean arterial pressure after insertion compared with the postinduction values within groups. Conclusion:GlideScope is superior to ILMA in terms of lower insertion and intubation times and lower levels of mucosal damage in cervical collar-immobilized patients.

Airway management in patients with suspected or confirmed cervical spine injury

“…success rates), rather than safety (cervical spine movement). Tracheal intubation through an LMA® Fastrach™ (Teleflex Medical Europe Ltd., Athlone, Ireland) is associated with similar success rates when compared with McCoy laryngoscopy (Penlon, Oxford, UK), the perilaryngeal airway (CobraPLA®; Engineered Medical Systems, Indianapolis, IN, USA) or LMA CTrach™ (Teleflex Incorporated) or Glidescope® (Verathon, Bothell, WA, USA) [28–31], lower success rate when compared with C‐MAC® (Karl Storz SE & Co. KG, Tuttlingen, Germany) [32], and greater success rate than tracheal intubation through a LMA Classic™ (Teleflex Incorporated) [33]. There were no clinically important differences between other supraglottic airway devices and means for achieving tracheal intubation [34, 35].…”

New Flexible Tip Bougie catheter for difficult airway intubation. A randomized, crossover pilot study

“…Performed with a Miller or Macintosh blade laryngoscope in many cases can be difficult to perform or completely ineffective. This is particularly the case when intuba- tion is performed by people without direct laryngoscopy experience [8][9][10][11], during cardiopulmonary resuscitation, when continuous chest compression is performed [12][13][14], in the case of intubation of patients with immobilized cervical spine [15][16][17], or patients with difficult airways [18][19][20].…”

King Vision vs. Intubating Laryngeal Mask Airway (ILMA) For Intubation of Obese Patients

“…Özdil S et al [12] compared ILMA and Glidecope for intubation of patients with rigid neck collar and demonstrated that success rate was 96% in both groups, both insertion and intubation times were longer for ILMA (21.9 ± 6.5 s and 48.4 ± 11 s), total time for intubation was longer for ILMA (85.6 ± 13 s), damage to mucosa was higher with ILMA, and both devices increased HR and blood pressure.…”