Tracheal intubation with videolaryngoscopes in patients with cervical spine immobilization: A randomized trial of the Airway Scope® and the GlideScope®

Abstract

Background: The GlideScope® (Verathon Inc., Bothell, WA, USA) and Airway Scope® (Hoya Corp., Tokyo, Japan) have both been used for difficult airway management, including in patients with cervical spine pathology. The Airway Scope®'s disposable blade has a tube channel to guide tracheal tube insertion through the glottis. Our hypothesis is that this tube guidance system improves the ease of tracheal intubation compared with the GlideScope®, which does not have a tube guiding system. We tested this hypothesis in a randomized comparison of the two videolaryngoscopes in patients whose cervical spines were immobilized. Methods: Seventy consenting patients were randomized to have tracheal intubation with the GlideScope® (n=35) or the Airway Scope® (n=35). In all patients, we applied manual in-line stabilization of the cervical spine throughout airway management. All the airway procedures were carried out by two anaesthetists experienced in the use of both videolaryngoscopes. Results: The tracheal intubation time was 34.2 (sd 25.1) s with the Airway Scope® compared with 71.9 (47.9) s with the GlideScope® (P<0.001). Tracheal intubation was successful with the Airway Scope® in 35 (100%) patients compared with 31 (88.6%) patients with the GlideScope® (P=0.114). Tracheal intubation was successful within 60 s in 33 (94.3%) patients with the Airway Scope® and 22 (62.9%) patients with the GlideScope® (P=0.003). Conclusions: These results suggest that the Airway Scope®'s tube guide system enables more rapid tracheal intubation compared with the GlideScope® in patients with cervical spine immobilization. © The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.