Cervical spine movement using the Airway Scope

Background The Airway Scope (AWS, AWS-S100; Hoya-Pentax, Tokyo, Japan), a recently introduced video laryngoscope, has been reported to reduce movement of the cervical spine during intubation attempts in comparison with conventional laryngoscopes. Use of the bougie as an aid for the AWS may cause further reduction. The authors compared cervical spine movement during intubation with the AWS with and without a bougie. Methods Thirty patients without cervical spine abnormality were randomized into two groups: intubation with AWS only and intubation with the AWS and the bougie. The cervical spine motion between the occiput (C0) and the fourth cervical vertebra (C4) was observed fluoroscopically, and change in movement between adjacent vertebrae created by each intubation method was compared. Time to intubation was also measured. Results Laryngoscopy with the AWS produced extension of the cervical spine segments assessed (C0-4). Median extension angle of the C0-4 during intubation using the AWS was reduced from 16.0 degrees without the bougie to 6.5 degrees with the bougie (P < 0.01). There was no significant difference in time to intubation between them. Conclusions Use of the bougie resulted in significantly reduced extension of the cervical spine during intubation attempt with the AWS in patients with a normal cervical spine.

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Cervical spine movement during orotracheal intubation: comparison of the Belscope and Macintosh blades

Anaesthesia ◽

10.1111/j.1365-2044.1994.tb04448.x ◽

2007 ◽

Vol 49 (9) ◽

pp. 772-774 ◽

Cited By ~ 7

Author(s):

N. M. GAJRAJ ◽

D. P. CHASON ◽

V. E. SHEARER

Keyword(s):

Cervical Spine ◽

Orotracheal Intubation ◽

Spine Movement

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Comparison of the Bullard and Macintosh Laryngoscopes for Endotracheal Intubation of Patients with a Potential Cervical Spine Injury

Anesthesiology ◽

10.1097/00000542-199712000-00012 ◽

1997 ◽

Vol 87 (6) ◽

pp. 1335-1342 ◽

Cited By ~ 97

Author(s):

Andrew D. J. Watts ◽

Adrian W. Gelb ◽

David B. Bach ◽

David M. Pelz

Keyword(s):

Cervical Spine ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Cervical Spine Injury ◽

Cricoid Pressure ◽

Macintosh Laryngoscope ◽

Spine Injury ◽

Neck Extension ◽

Bullard Laryngoscope ◽

Spine Movement

Background In the emergency trauma situation, in-line stabilization (ILS) of the cervical spine is used to reduce head and neck extension during laryngoscopy. The Bullard laryngoscope may result in less cervical spine movement than the Macintosh laryngoscope. The aim of this study was to compare cervical spine extension (measured radiographically) and time to intubation with the Bullard and Macintosh laryngoscopes during a simulated emergency with cervical spine precautions taken. Methods Twenty-nine patients requiring general anesthesia and endotracheal intubation were studied. Patients were placed on a rigid board and anesthesia was induced. Laryngoscopy was performed on four occasions: with the Bullard and Macintosh laryngoscopes both with and without manual ILS. Cricoid pressure was applied with ILS. To determine cervical spine extension, radiographs were exposed before and during laryngoscopy. Times to intubation and grade view of the larynx were also compared. Results Cervical spine extension (occiput-C5) was greatest with the Macintosh laryngoscope (25.9 degrees +/- 2.8 degrees). Extension was reduced when using the Macintosh laryngoscope with ILS (12.9 +/- 2.1 degrees) and the Bullard laryngoscope without stabilization (12.6 +/- 1.8 degrees; P < 0.05). Times to intubation were similar for the Macintosh laryngoscope with ILS (20.3 +/- 12.8 s) and for the Bullard without ILS (25.6 +/- 10.4 s). Manual ILS with the Bullard laryngoscope results in further reduction in cervical spine extension (5.6 +/- 1.5 degrees) but prolongs time to intubation (40.3 +/- 19.5 s; P < 0.05). Conclusions Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.

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