A Comparison of Cervical Spine Movement during Tracheal Intubation when Using a Pentax Airway Scope or the GlideScope Video Laryngoscopy with Fluoroscopy

Abstract

Background: C-spine movement occurs during intubation, especially in patients with c-spine injuries; the result can have devastating neurologic outcomes. Videolaryngoscopes provide a better view of the glottis and less cervical spine movement. Objective(s): This study compared c-spine motion during tracheal intubation between the GlideScope video laryngoscope and the Pentax Airway Scope by using fluoroscopy. The primary outcome was the difference in c-spine motion. The secondary outcome was hemodynamic changes after intubation. Method(s): In the Pentax Airway Scope and GlideScope video laryngoscopy groups, we randomly allocated 200 patients who underwent elective noncardiac surgery and required general anesthesia with tracheal intubation. All patients underwent general anesthesia with the same induction medications, muscle relaxant, and opioid. During airway maneuvers, fluoroscopy was used to record cervical spine movements from the occiput down to C5 level. Vital signs were recorded after successful intubation. All images were measured by the radiologist consultant. Using the classic AutoCAD program, the angles between adjacent levels were calculated and shown as numbers (Fig. 1). Result(s): The Pentax Airway Scope and GlideScope induced the greatest c-spine movement in the C1-C2 segments, during each stage of the laryngoscopies. C-spine motion was not statistically different using either videolaryngoscopes at the five segments studied. The hemodynamic changes after intubation showed after the first and second minutes and there were significantly fewer blood pressure changes in the Pentax group. Conclusion(s): Cervical spine movement during tracheal intubation does not differ significantly between the Pentax Airway Scope and the GlideScope..