Ali YILMAZ, Alkin ÇOLAK, Elif ÇOPUROĞLU, Sevtap ŞAHİN HEKİMOĞLU, Nesrin TURAN

A comparison of the effects of different types of laryngoscope on the cervical motions: randomized clinical trial

Background: The rate of cervical injury among alltrauma patients is 3.1%. The most important point dur- ing intubation of those patients is not to increase thecervical injury. Aims: In this study, we hypothesize that there will be aminimal cervical extension during a laryngoscopy withthe use of optical view laryngoscopes. Study Design: Prospective, randomized clinicaltrial. Methods: One hundred and fifty adult patients withASA physical status I to III were enrolled in our study.After routine anesthesia induction, we randomly as- signed the patients into three groups according tothe type of laryngoscope. Macintosh type, TruviewEVO2® type and Airtraq® type laryngoscopes wereused in Group DL (n=50), Group TW (n=50) andGroup ATQ (n=50), respectively. After applying gen- eral anesthesia induction and mask ventilation, all ofthe patients were positioned in the neutral position.An inclinometer was placed on the forehead of thepatients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured andthe time to intubation was recorded.Results: One of the 50 patients in the DL Group, 2 of the50 patients in the TW Group, and 4 of the 50 patients inthe ATQ Group were excluded from the study becauseof the failure of intubation at defined times. The angleof cervical extension during laryngoscopy was foundto be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degreesin the Groups DL, TV and ATQ, respectively; thesedifferences also had statistical significance (p=0.000).The duration of intubation was found to be 13.59±5.49,23.60±15.23, and 29.80±13.82 seconds in Groups DL,TV and ATQ, respectively (p=0.000).Conclusion: A minimal cervical motion was obtainedduring tracheal intubation with the use of TruviewEVO2® and Airtraq® types of laryngoscope comparedwith the Macintosh laryngoscope. (ClinicalTrials.govIdentifier: NCT02191904).Keywords: Airtraq®, airway management, intratrachealequipment, intubation, Macintosh, Truview EVO2®

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1. Branco BC, Plurad D, Green DJ, Inaba K, Lam L, Cestero R, et al. Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: a National Trauma Databank review J Trauma 2011;70:111-5. [CrossRef]
2. Crosby ET. Airway management in adults after cervical spin trauma. Anesthesiology 2006;104:1293-318. [CrossRef]
3. Carlino C, Pastore JC, Battistini GM, Cancellieri F, De Cari D, Ruggieri N, et al. Training resident anesthesiologists in adu challenging intubation comparing TruView EVO2 and Macin tosh laryngoscope: a preliminary study. Minerva Anestesio 2009;75:563-7.
4. Turkstra TP, Pelz DM, Jones PM. Cervical spine motion: a fluoro scopic comparison of the AirTraq Laryngoscope versus the Macin tosh laryngoscope . Anesthesiology 2009;111:97-101. [CrossRef]
5. Saracoglu KT, Eti Z, Gogus FY. Airtraq optical laryngoscope advantages and disadvantages. Middle East J Anesthesio 2013;22:135-416.
6. Nasim S, Maharaj CH, Malik MA, O Donnell J, Higgins BD Laffey JG. Comparison of the Glidescope and Pentax AW laryngoscopes to the Macintosh laryngoscope for use by ad vanced paramedics in easy and simulated difficult intubation BMC Emerg Med 2009;17;9:9.
7. Malik MA, ODonoghue C, Carney J, Maharaj CH, Harte BH Laffey JG. Comparison of the Glidescope, the Pentax AWS and the Truview EVO2 with the Macintosh laryngoscop in experienced anaesthetists: a manikin study. Br J Anaest 2009;102:128-34. [CrossRef]
8. Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison o Macintosh, Truview EVO2, Glidescope, and Airwayscope la ryngoscope use in patients with cervical spine immobilization Br J Anaesth 2008;101:723-30. [CrossRef]
9. Brimacombe J, Keller C, Kunzel KH, Gaber O, Boehler M Puhringer F. Cervical spine motion during airway manage ment: a cinefluoroscopic study of the posteriorly destabilize third cervical vertebrae in human cadavers. Anesth Anal 2000;91:1274-8. [CrossRef]
10. Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine mo tion: a fluoroscopic comparison during intubation with lighte stylet, GlideScope, and Macintosh laryngoscope. Anesth Anal 2005;101:910-5. [CrossRef]
11. Hindman BJ, Santoni BG, Puttlitz CM, From RP, Todd MM Intubation biomechanics: laryngoscope force and cervical spin motion during intubation with Macintosh and Airtraq laryngo scopes . Anesthesiology 2014;121:260-71. [CrossRef]
12. Li JB, Xiong YC, Wang XL, Fan XH, Li Y, Xu H, et al. A evaluation of the TruView EVO2 laryngoscope. Anaesthesi 2007;62:940-3. [CrossRef]
13. Barak M, Philipchuck P, Abecassis P, Katz Y. A comparison o the Truview blade with the Macintosh blade in adult patients Anaesthesia 2007;62:827-31. [CrossRef]
14. Matsumoto S, Asai T, Shingu K. TruViewEVO2 videolaryngo scope. Masui 2007;56:213-7.https://webmail.tubitak.gov.tr/zimbra/?loginOp=logout
15. Matsumoto S, Asai T, Shingu K. Truview video laryngoscop in patients with difficult airways. Anesth Analg 2006;103 492-3. [CrossRef]
16. Kulkarni AP, Tirmanwar AS. Comparison of glottic visualisa- tion and ease of intubation with different laryngoscope blades. Indian J Anaesth 2013;57:170-4. [CrossRef]
17. McElwain J, Laffey JG. Comparison of the C-MAC(R), Airtraq(R), and Macintosh laryngoscopes in patients undergo- ing tracheal intubation with cervical spine immobilization. Br J Anaesth 2011;107:258-64. [CrossRef]
18. Arora S, Sayeed H, Bhardwaj N. A comparison of Truview EVO2 laryngoscope with Macintosh laryngoscope in routine airway management: A randomized crossover clinical trial. Sau - di J Anaesth 2013;7:244-8. [CrossRef]
19. Maharaj CH, Buckley E, Harte BH, Laffey JG. Endotracheal in- tubation in patients with cervical spine immobilization: a com- parison of macintosh and airtraq laryngoscopes. Anesthesiology 2007;107:53-9. [CrossRef]
20. Timanaykar RT, Anand LK, Palta S. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia. J Anaesthesiol Clin Pharmacol 2011;27:199-204. [CrossRef]