Cervical Spine Motion

Abstract

Background: The optimal technique to intubate the trachea in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using continuous fluoroscopic video assessment, C-spine motion during laryn-goscopy with an AirTraq Laryngoscope® (King Medical Sys-tems, Newark, DE) was compared to that with intubation using a Macintosh blade. Methods: Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and AirTraq laryngoscopy with manual inline stabilization after induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryn-goscopy was also measured. Results: C-spine motion using the AirTraq was less than that during Macintosh laryngoscopy, averaging 66% less (P < 0.01) at three of the motion segments studied, occiput-C1, C2-C5, and C5-thoracic. There was no difference at the C1-C2 segment. There was no significant difference in the time to accomplish laryngoscopy between the two devices. Conclusions: For patients in whom C-spine movement is undesirable, use of the AirTraq Laryngoscope® may be useful to limit movement without an increase in the duration of intubation. THERE is potential for spinal cord damage during tra-cheal intubation whenever the cervical spine (C-spine) is unstable 1–3 . A previous study demonstrated that maxi-mal C-spine movement occurs during intubation, as op-posed to the movement observed with careful bag-mask ventilation, making the choice of intubation technique germane.