Abstract
Purpose
The optimal technique to manage the airway in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using fluoroscopic video assessment, C-spine motion during laryngoscopy with a Shikani Optical Stylet® (SOS) was compared to C-spine motion during intubation using a Macintosh blade.
Methods
Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and Shikani laryngoscopy with manual inline stabilization following induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C 1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryngoscopy was also measured (duration > 120 sec was deemed a failure of the laryngoscopy technique).
Results
On average, C-spine motion was 52% less (P < 0.02) at three of the motion segments studied, occiput-C 1, C2-C5, and C5-thoracic when comparing SOS vs Macintosh laryngoscopy. There was no difference between techniques at the C1-C2 segment. Laryngoscopy with SOS (28 ± 17 sec) took longer than with Macintosh blade (17 ± 7 sec), P < 0.01. There were two failures out of 23 using the SOS, vs none with the Macintosh blade.
Conclusion
For patients in whom C-spine movement is undesirable, use of the SOS may limit neck movement, while modestly increasing the time required to intubate, and/or the risk of procedure failure.
Résumé
Objectif
La question de la technique optimale de prise en charge des voies aériennes des patients présentant une lésion potentielle ou documentée de la colonne cervicale demeure sans réponse. Par le biais d’une évaluation vidéo fluoroscopique, le mouvement de la colonne cervicale durant la laryngoscopie à l’aide d’un stylet optique Shikani® (SOS) a été comparé au même mouvement durant l’intubation effectuée avec une lame Macintosh.
Méthode
Vingt-quatre patients chirurgicaux sains ont accepté par écrit de participer à une étude randomisée contrôlée croisée; tous les patients ont eu une laryngoscopie avec lame Macintosh et stylet optique Shikani®, avec stabilisation manuelle en ligne, suite à l’induction de l’anesthésie. Le mouvement de la colonne cervicale a été observé à quatre endroits : la jonction occipitale-C1, la jonction C1-C2, le segment de mouvement C2-C5, et le segment de mouvement C5-thoracique. Le temps requis pour la laryngoscopie a également été mesuré (si la durée > 120 sec, nous avons considéré cela comme un échec de la technique laryngoscopique).
Résultats
Le mouvement de la colonne cervicale était en moyenne 52 % moins important (P < 0,02) à trois des segments de mouvements étudiés - occiput-C1, C2-C5, et C5-thoracique, en comparant la laryngoscopie avec SOS vs avec Macintosh. Aucune différence entre les techniques n’a été observée au segment C1-C2. La laryngoscopie avec SOS a nécessité 28 ± 17 sec en comparaison d’un temps de laryngoscopie plus court avec la lame Macintosh (17 ±7 sec, P <0,01 vs SOS). Deux échecs sur 23 ont eu lieu lors de l’utilisation du SOS, vs aucun avec la lame Macintosh.
Conclusion
Chez les patients où le mouvement de la colonne cervicale est à éviter, le recours au SOS peut limiter le mouvement du cou tout en augmentant quelque peu le temps nécessaire à l’intubation et/ou le risque d’un échec de la procédure.
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Turkstra, T.P., Pelz, D.M., Shaikh, A.A. et al. Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope. Can J Anesth 54, 441–447 (2007). https://doi.org/10.1007/BF03022029
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DOI: https://doi.org/10.1007/BF03022029