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

2009; Elsevier BV; Volume: 102; Issue: 5 Linguagem: Inglês

10.1093/bja/aep056

1471-6771

Muhammad Anwar Malik, Rajeshwari Subramaniam, S. Churasia, Chris Maharaj, B. H. Harte, John G. Laffey,

Head and Neck Surgical Oncology

BackgroundThe 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.MethodsNinety 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.ResultsThe 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.ConclusionsThe AWS® laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach®, in patients undergoing cervical spine immobilization. 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. 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. 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. The AWS® laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach®, in patients undergoing cervical spine immobilization.