Radiological Measurement of Cervical Angulation Comparing Direct Laryngoscopy with Miller Blade vs. lightwand
Keywords:
Intubation, Laryngoscopy, Radiometry, Cervical Vertebrae, Fluoroscopy
Abstract
Objective. To compare the cervical spine motion with direct laryngoscopy using the Miller blade with cervical protection, triple maneuver and intubation with lightwand in patients with no predictors of a difficult airway.
Methods. This is a series of 5 female patients who underwent elective embolization of cerebral arteriovenous malformations between January and March 2003, at the Fundación de Santa Fe University Hospital, Bogotá. Videofuoroscopic measurements were taken to determine the angular displacement of the cervical spine.
Results. Rhe study included five female patients with an average age of 43 years. C1 and C5 were the segments with greater displacement. Baseline measurements were taken with the head of the patient in neutral position to compare against subsequent measurements.
Less motion was observed at the segments with greater displacement (C1 y C5) with the use of the lightwand versus direct laryngoscopy with the Miller blade (8° vs. 13.2° at C1 and 6.4° vs. 15.6° at C5). The triple maneuver and the fixation of the endotracheal tube caused less angulation than the intubation maneuver.
Conclusions. Lightwand intubation could be a useful and safe alternative in patients with cervical spine disorders and movement limitations.
References
1. Sawin PD, Todd MM, Traynelis VC, Farrell SB, Nader A, Sato Y, 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.
2. Langeron O, Birenbaum A, Amour J. Airway management in trauma. Minerva Anestesiol. 2009;75(5): 307-11.
3. Suderman VS, Crosby ET, Lui A. Elective oral tracheal intubation in cervical spine- injured adults. Can J Anaesth. 1991;38(6):785-9.
4. Calder I, Calder J, Crockard HA. Difficult direct laryngoscopy in patients with cervical spine disease. Anaesthesia. 1995;50(9):756-63.
5. Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology. 1994;80(4):825-31.
6. Lennarson PJ, Smith D, Todd MM, Carras D, Sawin PD, Brayton J, et al. Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization. J Neurosurg. 2000;92(2Suppl):201-6.
7. McLeod ADM, Calder I. Spinal cord injury and direct laryngoscopy--the legend lives on. Br J Anaesth. 2000;84(6):705-9.
8. Bryson BL, Mulkey M, Mumford B. Cervical spine injury, incidence and diagnosis. J Trauma. 1986;26(7):669-74.
9. Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage: a closed claims analysis. Anesthesiology. 2006;105(6):1081-6.
10. American College of Surgeons Committee on Trauma. Advanced trauma life support course for doctors. 6th ed. Chicago: American College of Surgeons; 1997.
11. Nolan JP, Wilson ME. Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia. 1993;48(7):630-3.
12. Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology. 1994;80(4):825-31.
13. Heath KJ. The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia. 1994;49(10):843-5. [ Links ]
14. Hastings RH, Vigil AC, Hanna R, Yang BY, Sartoris DJ. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology. 1995; 82(4):859-69.
15. Watts AD, 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(6): 1335-42.
16. LeGrand SA, Hindman BJ, Dexter F, Weeks JB, Todd MM. Craniocervical motion during direct laryngoscopy and orotracheal intubation with the Macintosh and Miller blades: an in vivo cinefluoroscopic study. Anesthesiology. 2007;107(6):884-91.
17. Hung OR, Stewart RD. Lightwand intubation: I--a new lightwand device. Can J Anaesth. 1995;42(9):820-5.
18. Hung OR, Pytka S, Morris I, Murphy M, Steward RD. Lightwand intubation: II-- clinical trial of a new lightwand for tracheal intubation in patients with difficult airways. Can J Anaesth. 1995;42(9):826-30.
19. Paschen HR. Difficult airway management in trauma-transillumination devices. Trauma Care 99, Proceedings of the 12th Annual Trauma Anesthesia and Critical Care Symposium; 13-15 Mayo 1999, Chicago.
20. Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg. 2000;90(3):745-56.
21. Smith CE, DeJoy SJ. New equipment and techniques for airway management in trauma. Curr Opin Anaesthesiol. 2001;14(2):197-209.
22. Houde B, Williams SR, Cadrin-Chênevert A, Drolet P. A comparison of cervical spine motion during orotracheal intubation with the trachlight(r) or the flexible fiberoptic bronchoscope. Anesth Analg. 2009;108(5):1638-43.
23. Inoue Y, Koga K, Shigematsu A. A comparison of two tracheal intubation techniques with trachlight and Fastrach in patients with cervical spine disorders. Anesth Analg. 2002;94(3):667-71.
24. Turkstra TP, Craen R, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg. 2005;101(3):910-5.
2. Langeron O, Birenbaum A, Amour J. Airway management in trauma. Minerva Anestesiol. 2009;75(5): 307-11.
3. Suderman VS, Crosby ET, Lui A. Elective oral tracheal intubation in cervical spine- injured adults. Can J Anaesth. 1991;38(6):785-9.
4. Calder I, Calder J, Crockard HA. Difficult direct laryngoscopy in patients with cervical spine disease. Anaesthesia. 1995;50(9):756-63.
5. Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology. 1994;80(4):825-31.
6. Lennarson PJ, Smith D, Todd MM, Carras D, Sawin PD, Brayton J, et al. Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization. J Neurosurg. 2000;92(2Suppl):201-6.
7. McLeod ADM, Calder I. Spinal cord injury and direct laryngoscopy--the legend lives on. Br J Anaesth. 2000;84(6):705-9.
8. Bryson BL, Mulkey M, Mumford B. Cervical spine injury, incidence and diagnosis. J Trauma. 1986;26(7):669-74.
9. Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage: a closed claims analysis. Anesthesiology. 2006;105(6):1081-6.
10. American College of Surgeons Committee on Trauma. Advanced trauma life support course for doctors. 6th ed. Chicago: American College of Surgeons; 1997.
11. Nolan JP, Wilson ME. Orotracheal intubation in patients with potential cervical spine injuries. An indication for the gum elastic bougie. Anaesthesia. 1993;48(7):630-3.
12. Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology. 1994;80(4):825-31.
13. Heath KJ. The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia. 1994;49(10):843-5. [ Links ]
14. Hastings RH, Vigil AC, Hanna R, Yang BY, Sartoris DJ. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology. 1995; 82(4):859-69.
15. Watts AD, 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(6): 1335-42.
16. LeGrand SA, Hindman BJ, Dexter F, Weeks JB, Todd MM. Craniocervical motion during direct laryngoscopy and orotracheal intubation with the Macintosh and Miller blades: an in vivo cinefluoroscopic study. Anesthesiology. 2007;107(6):884-91.
17. Hung OR, Stewart RD. Lightwand intubation: I--a new lightwand device. Can J Anaesth. 1995;42(9):820-5.
18. Hung OR, Pytka S, Morris I, Murphy M, Steward RD. Lightwand intubation: II-- clinical trial of a new lightwand for tracheal intubation in patients with difficult airways. Can J Anaesth. 1995;42(9):826-30.
19. Paschen HR. Difficult airway management in trauma-transillumination devices. Trauma Care 99, Proceedings of the 12th Annual Trauma Anesthesia and Critical Care Symposium; 13-15 Mayo 1999, Chicago.
20. Davis L, Cook-Sather SD, Schreiner MS. Lighted stylet tracheal intubation: a review. Anesth Analg. 2000;90(3):745-56.
21. Smith CE, DeJoy SJ. New equipment and techniques for airway management in trauma. Curr Opin Anaesthesiol. 2001;14(2):197-209.
22. Houde B, Williams SR, Cadrin-Chênevert A, Drolet P. A comparison of cervical spine motion during orotracheal intubation with the trachlight(r) or the flexible fiberoptic bronchoscope. Anesth Analg. 2009;108(5):1638-43.
23. Inoue Y, Koga K, Shigematsu A. A comparison of two tracheal intubation techniques with trachlight and Fastrach in patients with cervical spine disorders. Anesth Analg. 2002;94(3):667-71.
24. Turkstra TP, Craen R, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg. 2005;101(3):910-5.
How to Cite
1.
Ni´ño MC, Ramirez FJ, Pérez Pradilla AC. Radiological Measurement of Cervical Angulation Comparing Direct Laryngoscopy with Miller Blade vs. lightwand. Colomb. J. Anesthesiol. [Internet]. 2011 Jan. 1 [cited 2024 Apr. 20];39(1):119-27. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/738
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Published
2011-01-01
How to Cite
1.
Ni´ño MC, Ramirez FJ, Pérez Pradilla AC. Radiological Measurement of Cervical Angulation Comparing Direct Laryngoscopy with Miller Blade vs. lightwand. Colomb. J. Anesthesiol. [Internet]. 2011 Jan. 1 [cited 2024 Apr. 20];39(1):119-27. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/738
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Case Report / Case Series
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