Comparison of Airtraq and Fiberoptic-Guided Intubation in the Presence of Rigid Cervical Collar Simulating Cervical Immobilization in Cervical Spine Surgery

Keywords

videolaryngoscope - fiberoptic-guided intubation - bronchoscopy

Introduction: Fiberopticbronchoscopy (FOB)-guided tracheal intubation remains the gold standard for the management of difficult airway, but its use may be limited by availability, lack of expertise, and additional time for bronchoscopy. Airtraq videolaryngoscope provides view of glottis without aligning oral, pharyngeal, and laryngeal axes.

Aim: To test whether Airtraq provides better intubating conditions over FOB.

Methodology/Description: After approval from ethics committee and written informed consent, comparative randomized intervention study was conducted. Forty-four patients were randomly assigned to receive oral intubation by Air-traq or fiberoptic. In all these patients, neck was immobilized with rigid cervical collar. We compared two airway devices for time to intubate, success rate of intubation, glottis view using Cormack and Lehane scoring system, hemodynamic changes, and postoperative complications. Patients who were obese, at risk of gastric aspiration, Mallampati class 3 or 4, thyromental distance < 6 cm, interincisor gap < 3.5 cm were excluded.

Results: Airtraq-guided intubation in simulated cervical spine injury patients required significantly shorter time for laryngoscopy (14.64 +/− 8.38 vs. 23.45 +/− 7.998) and intubation as compared with fiberoptic-guided intubation (29.95 +/− 4.61 sec vs. 38.73 +/− 11.752 sec). Both the techniques were comparable in terms of success rate of intubation, glottis view, and hemodynamics.

Conclusion: Airtraq videolaryngoscope can be successfully used as alternative to FOB in cervical spine injury patients.

• References

• 1 Durga P, Sahu BP. Neurological deterioration during in-tubation in cervical spine disorders.. Indian J Anaesth 2014; 58 (06) 684-692
• 2 Hastings RH, Delson N. Balancing the force of direct laryngoscopy with manual in-line stabilization.. Anesthesiology 2009; 111 (05) 1158-1160 author reply 1159–1160