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J Neuroanaesth Crit Care 2018; 05(01): S1-S27
DOI: 10.1055/s-0038-1636411
Abstracts
Thieme Medical and Scientific Publishers Private Limited

Cervical Spine Movement during Awake Orotracheal Intubation with Fiberoptic Scope and McGrath VideoLaryngoscope in Patients Undergoing Surgery for Unstable Cervical Spine

K. Dutta
1   Department of Neuroanaesthesia and Neurocritical Care, NIMHANS, Bengaluru, Karnataka, India
,
M. Reddy
1   Department of Neuroanaesthesia and Neurocritical Care, NIMHANS, Bengaluru, Karnataka, India
,
K. Sriganesh
1   Department of Neuroanaesthesia and Neurocritical Care, NIMHANS, Bengaluru, Karnataka, India
,
C. Dhritiman
1   Department of Neuroanaesthesia and Neurocritical Care, NIMHANS, Bengaluru, Karnataka, India
,
N. Pruthi
1   Department of Neuroanaesthesia and Neurocritical Care, NIMHANS, Bengaluru, Karnataka, India
› Author Affiliations
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Publication History

Publication Date:
09 February 2018 (online)

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Keywords

UCS - VGI - FGI

Introduction: Cervical spine (c-spine) movement during intubation with direct laryngoscopy (DL) can cause new-onset neurological deficits in patients with unstable cervical spine (UCS). While fiberoptic intubation is preferred, this is not always possible. Intubation using videolaryngoscope causes lesser C-spine movement than DL and may be better option for intubation in these patients. The primary objective of this study was to compare C-spine movement during awake fiberoptic-guided intubation (FGI) and McGrath videolaryngoscope-guided intubation (VGI) in patients undergoing surgery for UCS.

Methodology/Description: Following ethics committee approval and informed consent, 21 patients with UCS scheduled for fixation surgery were recruited over 1-year. Patients were included if they were 18 to 65 years and had upper C-spine instability. Based on computer-generated table, patients were randomized to FGI or VGI. Awake intubation was facilitated with airway blocks and fentanyl. C-spine movement during intubation was assessed by lateral fluoroscopy at three-time points (T1-baseline, T2-during glottis view, and T3-with tube in-situ). Motor power was assessed before and after intubation.

Results: The most common diagnosis was atlantoaxial dislocation followed by C1 or odontoid fracture. The mean age was 34.73 (13.63) and 33.70 (11.0) years in VGI and FGI groups, respectively. The degree of motion at C1/2 was 7.2 ± 1.9 in FGI and 6.5 ± 2.1 in VGI (p = 0.863). The movement at C3 was 5.01 ± 0.91 in FGI and 5.93 ± 2.52 in VGI. No patient developed new-onset deficits.

Conclusion: The degree of cervical spine movement was similar with both the techniques and no patient developed intubation-related motor deficits.


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