Degree of cervical mobility differs or not when using alternative way of intubation: Intubating laryngeal mask or classic laryngoscope

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Abstract

Background

Spine surgery needs a special consideration as regards minimizing the movement during intubation to avoid the hazards to spinal cord. The present study aims to highlight the preferable technique for cervical intubation. The Intubating Laryngeal Mask Airway (ILMA, Fastrach™ laryngeal mask company, Henle-on-Thomes, U.K.) is a supraglottic device specially designed to be an effective ventilator device and blind intubation guide in patient with normal and abnormal airways.

Methods

40 patients were involved and randomly assigned to two equal groups according to the used technique of endotracheal intubation: (Group 1): Intubating Laryngeal Mask technique and (Group 2): Direct laryngoscopy technique. Anesthesia was induced using a combination of 1 μg/kg fentanyl, 5 mg/kg thiopental sodium (sleeping dose) and atracurium 0.5 mg/kg (Intubating laryngeal Mask or the Macintosh blade) was used to secure the airway according to the patient group. Meanwhile a continuous videofluoroscopy was recorded. The radiographs were analyzed for movements in the cervical segments C1/2 and C2/3. A reference line was drawn following the dorsal alignment of C2. Another two lines, one connecting the anterior and posterior arch of C1, and one through the basal plate of C3, were drawn to transect the above mentioned reference line.

Results

The mean cervical spine extension at C1/C2 was 77.2 ± 3.5 before intubation, 74.8 ± 4.3 during intubation, and 75.9 ± 4.2 after intubation for group 1, while it was 74.95 ± 4 before, 65.9 ± 4.4 during, and 68.75 ± 3.9 after intubation for group 2 there was statistically significant difference between LMA group (group 1) and direct laryngoscopy group (group 2) in the motion of cervical spine extension at C1/C2 during and after intubation where the p-value was <0.05.

Conclusion

The ILM (Fastrach) is a satisfactory alternative to the currently used methods of airway management in cervical spine injuries and reduces movement of the cervical spine.

Keywords:

• Intubation
• Cervical spine
• Airway difficulty
• Intubating laryngeal mask

Notes

Peer review under responsibility of Egyptian Society of Anesthesiologists.