BJA Advance Access originally published online on February 3, 2009
British Journal of Anaesthesia 2009 102(3):424-430; doi:10.1093/bja/aep002
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Cervical spine motion during flexible bronchoscopy compared with the Lo-Pro GlideScope®
1 Department of Anaesthesia
2 Department of Radiology
3 Department of Neurosurgery, Toronto Western Hospital, Canada
4 Department of Anaesthesia, Toronto General Hospital, Canada
* Corresponding author: PO Box 741, South Melbourne, VIC 3205, Australia. E-mail: danielm.ywong{at}gmail.com
Background: The most appropriate device for tracheal intubation in patients with potential cervical spine injury remains controversial. We hypothesized that the Lo-Pro GlideScope® (LP-G) videolaryngoscope would not cause significantly greater cervical spine movement than fibreoptic bronchoscopy even in the non-immobilized spine.
Methods: Twenty-eight healthy adults requiring intubation for radiographic procedures were randomized to either the LP-G or the flexible bronchoscope (FB) devices. Continuous fluoroscopy was used to assess cervical spine movement during tracheal intubation. The point of maximum movement was compared with baseline for change in angulation between Occiput (Occ)-C1, Occ-C2, Occ-C4, Occ-C5, C1–2, C2–4, and C4–5. Measurements were made by two independent observers. The change in angulation was also measured for tongue pull and jaw thrust, manoeuvres for enlarging the pharyngeal space, before FB intubation.
Results: LP-G resulted in greater cervical extension compared with FB for every angle calculated, statistically significant between Occ-C1 (P<0.05), Occ-C2 (P<0.05), and Occ-C4 (P<0.01). Tongue pull resulted in significantly less cervical spine motion than FB intubation at Occ-C1, Occ-C2, Occ-C4, and Occ-C5 (P<0.05). When jaw thrust was added to tongue pull, there was a tendency for greater movement than FB intubation at Occ-C1, Occ-C2, and Occ-C3. This was statistically significant at Occ-C1 and Occ-C3 (P<0.05) for one of the two observers.
Conclusions: During intubation under general anaesthesia, LP-G resulted in greater cervical movement than FB when no cervical immobilization was used in adults without cervical disease. Airway manoeuvres performed before FB, especially jaw thrust, also resulted in cervical spine movement.
Keywords: airway; anaesthetic techniques, bronchoscopy; anaesthetic techniques, laryngoscopy; equipment, laryngoscopes fibreoptic; monitoring, radiological
5 Present address: Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia