Video Laryngoscopic Intubation Using the King VisionTM Laryngoscope in a Simulated Cervical Spine Trauma: A Comparison Between Non-Channeled and Channeled Disposable Blades

Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9–19) vs. 23 s (14.5–37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.

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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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Fiberoptic Tracheal Intubation Through the Laryngeal Mask in an Awake Patient with Cervical Spine Injury

Anesthesia & Analgesia ◽

10.1213/00000539-199377020-00040 ◽

1993 ◽

Vol 77 (2) ◽

pp. 404

Author(s):

&NA;

Keyword(s):

Cervical Spine ◽

Tracheal Intubation ◽

Cervical Spine Injury ◽

Laryngeal Mask ◽

Spine Injury ◽

Awake Patient

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Comparative evaluation of ease of tracheal intubation using Airtraq and intubating laryngeal mask airway with cervical spine immobilization

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.034 ◽

2021 ◽

Vol 8 (2) ◽

pp. 161-166

Author(s):

Lalit Gupta ◽

Deepak Kumar ◽

Sonia Wadhawan ◽

Sivaraj ◽

Amit Kohli ◽

...

Keyword(s):

Cervical Spine ◽

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Cervical Spine Injury ◽

Laryngeal Mask ◽

Spine Injury ◽

Neutral Position ◽

Group I ◽

Intubating Laryngeal Mask Airway ◽

Group A

Tracheal intubation in cervical spine injury patients with application of Manual In Line Stabilization (MILS) of the cervical spine in neutral position is a challenge for the anesthesiologist since it makes visualization of the larynx more difficult using conventional laryngoscopy. Our study was conducted to compare ease of intubation using Airtraq and Intubating laryngeal mask airway(ILMA) in simulated cervical spine injury patient using MILS. 100 ASA I/II patients (without cervical spine injury), aged 18-60 years were randomly allocated in two groups -Group A: Airtraq (n=50), Group I: ILMA (n=50). General anaesthesia was given as per standard protocol in all the patients, after that MILS was applied and patients intubated using Airtraq in group A and ILMA in group I with neck in neutral position. Time taken for intubation, number of attempts for intubation, ease of intubation with Airtraq/ILMA, hemodynamics and complications were compared.The mean time taken for intubation in the Group A was 12.6 ± 6.6 seconds and in the Group, I was 85.8 ± 36.6 seconds (p<0.001). Number of intubations attempts in Group A was significantly less as compared to the Group I (p= 0.027).Airtraq is a safer and faster alternative when compared to ILMA in patients with simulated cervical spine injury using manual in line stabilization.

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