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BJA Advance Access published online on March 31, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep056
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope®, LMA CTrach®, and the Macintosh laryngoscopes

M. A. Malik1,2, R. Subramaniam1, S. Churasia1, C. H. Maharaj3, B. H. Harte1 and J. G. Laffey1,2,*

1 Department of Anaesthesia, Galway University Hospitals
2 Clinical Research Facility, National University of Ireland, Galway, Ireland
3 Department of Anaesthesia, Sligo General Hospital, Sligo, Ireland

* Corresponding author. E-mail: john.laffey{at}nuigalway.ie

Background: The purpose of this study was to evaluate the effectiveness of the Pentax AWS®, and the LMA CTrach®, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

Methods: Ninety patients undergoing anaesthesia who required tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n=30), LMA CTrach® (n=30), or AWS® (n=30) laryngoscope. All patients were intubated by one of the three anaesthetists familiar with the use of each laryngoscope.

Results: The intubation difficulty scores were significantly higher with the Macintosh laryngoscope and were significantly lower with the AWS® compared with the LMA CTrach. All 30 patients were successfully intubated with the Macintosh and the AWS® device, compared with 27 patients with the LMA CTrach®. The duration of both the first and the successful tracheal intubation attempts was significantly longer with the LMA CTrach® compared with the AWS® and Macintosh laryngoscopes. A greater number of optimization manoeuvres were required to facilitate tracheal intubation with the LMA CTrach® compared with the AWS® laryngoscope. The AWS® group had a significantly better Cormack and Lehane glottic view obtained at laryngoscopy compared with both other devices.

Conclusions: The AWS® laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach®, in patients undergoing cervical spine immobilization.

Keywords: equipment, AWS® laryngoscope; equipment, Macintosh laryngoscope; difficult intubation; intubation, tracheal; LMA CTrach®; neck immobilization


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Home page
 Br J AnaesthHome page
M. A. Malik, R. Subramaniam, C. H. Maharaj, B. H. Harte, and J. G. Laffey
Randomized controlled trial of the Pentax AWS(R), Glidescope(R), and Macintosh laryngoscopes in predicted difficult intubation
Br. J. Anaesth., November 1, 2009; 103(5): 761 - 768.
[Abstract] [Full Text] [PDF]


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