Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach, and the Macintosh laryngoscope
Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach, and the Macintosh laryngoscope
Background/aim: The optimal technique for airway management in patients with cervical pathology remains unclear. Intubatinglaryngeal mask airway devices such as LMA CTrach and LMA Fastrach have not been compared for cervical spine (C-spine) movementsin the context of cervical pathology. The present study aimed to determine upper C-spine movements by radiography during intubationwith different devices as well as comparing the duration and success of intubation in cervical surgery.Materials and methods: Sixty patients scheduled for elective cervical surgery were registered in this prospective, randomized study.Patients with cervical trauma/injury, previous neck surgery, and body mass index (BMI) of >35 kg/m2 were excluded. Participants wererandomized to one of the 3 groups: LMA CTrach, LMA Fastrach, or the Macintosh laryngoscope. C-spine motion was evaluated bymeasuring angles created by bordering vertebrae at cervical 1/2 and 2/3 (C1/2, C2/3) segments on 2 lateral cervical radiographs for eachpatient. Intubation time, ease of intubation, number of attempts, and success rate were also documented.Results: Demographic data were similar in all the groups. The cervical movement with LMA CTrach and LMA Fastrach compared tothe Macintosh laryngoscope were similar at C1/2. However, LMA CTrach significantly reduced extension compared to LMA Fastrachand Macintosh laryngoscopes at C2/3. Duration of intubation was significantly shorter with the Macintosh laryngoscope. The rate ofsuccessful intubation was 80% with LMA Fastrach and 100% with both LMA CTrach and the Macintosh laryngoscopes.Conclusion: The LMA CTrach laryngoscopy involves less upper C-spine movement than the LMA Fastrach and does not increase theduration of the intubation period.
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- 1. Duggan LV, Griesdale DE. Secondary cervical spine injury
during airway management: beyond a ‘one-size-fits-all’
approach. Anaesthesia 2015; 70 (7): 769-773. doi: 10.1111/
anae.13163
- 2. Farag E. Airway management for cervical spine surgery. Best
Practice & Research Clinical Anaesthesiology 2016; 30 (1): 13-
25. doi: 10.1016/j.bpa.2016.01.001
- 3. Prasarn ML, Conrad B, Rubery PT, Wendling A, Aydog
T et al. Comparison of 4 airway devices on cervical spine
alignment in a cadaver model with global ligamentous
instability at C5-C6. Spine 2012; 37 (6): 476-481. doi: 10.1097/
BRS.0b013e31822419fe
- 4. Sawin PD, Todd MM, Traynelis VC, Farrell SB, Nader A
et al. Cervical spine motion with direct laryngoscopy and
orotracheal intubation: an in vivo cinefluoroscopic study of
subjects without cervical abnormality. Anesthesiology 1996; 85
(1): 26-36.
- 5. Suppan L, Tramèr MR, Niquille M, Grosgurin O, Marti C.
Alternative intubation techniques vs Macintosh laryngoscopy
in patients with cervical spine immobilization: systematic
review and meta-analysis of randomized controlled trials.
British Journal of Anaesthesia 2016; 116: 27-36. doi: 10.1093/
bja/aev205
- 6. Sahin A, Salman MA, Erden IA, Aypar U. Upper cervical
vertebrae movement during intubating laryngeal mask,
fibreoptic and direct laryngoscopy: a video-fluoroscopic study.
European Journal of Anaesthesiology 2004; 21 (10): 819-823.
- 7. Liu EHC, Goy RWL, Chen FG. The LMA CTrachTM, a new
laryngeal mask airway for endotracheal intubation under
vision: evaluation in 100 patients. British Journal of Anaesthesia
2006; 96: 396-400. doi: 10.1097/ALN.0b013e31819b62c7
- 8. Liu EH, Wender R, Goldman AJ. The LMA CTrach™ in Patients
with Difficult Airways. Anesthesiology 2009; 110: 941-943.
- 9. Kılıç T, Goksu E, Durmaz D, Yıldız G. Upper cervical spine
movement during intubation with different airway devices.
American Journal of Emergency Medicine 2013; 31 (7): 1034-
1036. doi: 10.1016/j.ajem.2013.03.029
- 10. Kihara S, Watanabe S, Brimacombe J, Taguchi N, Yaguchi Y
et al. Segmental cervical spine movement with the intubating
laryngeal mask during manual in-line stabilization in patients
with cervical pathology undergoing cervical spine surgery.
Anesthesia & Analgesia 2000; 91: 195-200.
- 11. Waltl B, Melischek M, Schuschnig C, Kabon B, Erlacher W
et al. Tracheal intubation and cervical spine excursion: direct
laryngoscopy vs. intubating laryngeal mask. Anaesthesia 2001;
56: 221-226.
- 12. Wendling AL, Tighe PJ, Conrad BP, Baslanti TO, Horodyski
M et al. A comparison of 4 airway devices on cervical spine
alignment in cadaver models of global ligamentous instability
at c1-2. Anesthesia & Analgesia 2013; 117: 126-132. doi:
10.1213/ANE.0b013e318279b37a
- 13. Bilgin H, Bozkurt M. Tracheal intubation using the ILMA,
C-Trach or McCoy laryngoscope in patients with simulated
cervical spine injury. Anaesthesia 2006; 61: 685-691.
- 14. Liu EH, Goy RW, Lim Y, Chen FG. Success of tracheal intubation
with intubating laryngeal mask airways: a randomized trial of
the LMA Fastrach and LMA CTrach. Anesthesiology 2008;
108: 621-626. doi: 10.1097/ALN.0b013e318167af61
- 15. Watts DJ, Gelb AW, Bach DB, Pelz DM. Comparison of
the Bullard and Macintosh laryngoscopes for endotracheal
intubation of patients with a potential cervical spine injury.
Anesthesiology 1997; 87: 1335-1342
- 16. Hindman BJ, Santoni BG, Puttlitz CM, From RP, Todd MM.
Intubation biomechanics: laryngoscope force and cervical
spine motion during intubation with Macintosh and Airtraq
laryngoscopes. Anesthesiology 2014; 121: 260-271. doi:
10.1097/ALN.0000000000000263
- 17. Komatsu R, Nagata O, Kamata K, Yamagata K, Sessler DI et
al. Intubating laryngeal mask airway allows tracheal intubation
when the cervical spine is immobilized by a rigid collar. British
Journal of Anaesthesia 2004; 93: 655-659.
- 18. Panjabi MM, Thibodeau LL, Crisco JJ 3rd, White AA 3rd. What
constitutes spinal instability? Clinical Neurosurgery 1988; 34:
313-339.
- 19. Baskett PJ, Parr MJ, Nolan JP. The intubating laryngeal mask.
Results of a multicentre trial with experience of 500 cases.
Anaesthesia 1998; 53: 1174-1179.
- 20. Ghafoor AU, Martin TW, Gopalakrishnan S, Viswamitra S.
Caring for the patients with cervical spine injuries: what have
we learned? Journal of Clinical Anesthesia 2005; 17: 640-649.
- 21. Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian
A. Use of the intubating LMA-Fastrach in 254 patients with
difficult-to-manage airways. Anesthesiology 2001; 95: 1175-
1181.