Download PDF
J Neuroanaesth Crit Care 2018; 05(01): S1-S27
DOI: 10.1055/s-0038-1636390
Abstracts
Thieme Medical and Scientific Publishers Private Limited

ILMA-Guided Flexible Bronchoscopic Intubation Is Associated with Reduced Cervical Spine Motion when Compared to Video Laryngoscopic Intubation

Amlan Swain
1   Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
,
Hemant Bhagat
2   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Vivek Gupta
3   Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
,
Seelora Sahu
1   Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
› Author Affiliations
Further Information

Publication History

Publication Date:
09 February 2018 (online)

Also available at
 
 PDF Download Permissions and Reprints

Keywords

flexible bronchoscopy-guided technique - video laryngoscopy-guided intubation - ILMA

Introduction: The study of cervical spine mechanics during airway interventions is a gradually evolving realm of scientific study in an attempt to limit cervical spine movement during endotracheal intubation. In a similar pursuit, we compared the cervical spine motion during orotracheal intubation using intubating laryngeal mask airway (ILMA)-guided flexible bronchoscope with intubation aided by video laryngoscope.

Methodology: Forty consenting patients without any history of known cervical spine abnormalities posted for elective neuroradiological procedures in the angiography suite were enrolled in the randomized crossover trial. All patients were randomized to both ILMA-guided flexible bronchoscopic and video laryngoscopic-guided intubation. The cervical spine motion was examined using continuous cinefluoroscopy at the following regions: occipital bone, C1, C2, C3, C4, C5 vertebra, the occiput-C1, C1–C2, C2–C3, and C4–C5 junction. The combined craniocervical motion from occiput to C5 between the two intubation techniques was the primary outcome of the study.

Results: Analysis of combined craniocervical movement from occiput to C5 revealed lesser movement (62% less) by the ILMA flexible bronchoscopy-guided technique as compared with video laryngoscopy-guided intubation (17.55 ± 14.23 vs. 28.95 ± 11.58 degrees, p < 0.001). The ILMA flexible bronchoscopy-guided technique produced significantly lesser movement as compared with the video laryngoscope at the occiput-C1 (9.75 ± 8.59 vs. 15.00 ± 10.48 degrees, p = 0.000) and C1-C2 level (3.95 ± 7.51 vs. 7.53 ± 9.1 degrees, p = 0.003).

Conclusion: The use of ILMA-guided flexible bronchoscopic intubation is associated with significantly reduced craniocervical and upper cervical spine movement when compared with intubation aided by video laryngoscopy.


#

  • References

  • 1 Sawin PD, Todd MM, Traynelis VC. et al. Cervical spine motion with direct laryngoscopy and orotracheal intubation. An in vivo cinefluoroscopic study of subjects without cervical abnormality.. Anesthesiology 1996; 85 (01) 26-36
    CrossrefPubMedSearch in Google Scholar
  • 2 Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope.. Anesth Analg 2005; 101 (03) 910-915
    CrossrefPubMedSearch in Google Scholar

  • References

  • 1 Sawin PD, Todd MM, Traynelis VC. et al. Cervical spine motion with direct laryngoscopy and orotracheal intubation. An in vivo cinefluoroscopic study of subjects without cervical abnormality.. Anesthesiology 1996; 85 (01) 26-36
    CrossrefPubMedSearch in Google Scholar
  • 2 Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope.. Anesth Analg 2005; 101 (03) 910-915
    CrossrefPubMedSearch in Google Scholar

  Permissions and Reprints