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Assessment Of Difficulty During Orotracheal Intubation In Patients With Cervical Spine Immobilisation - A Comparison Of Macintosh And Truview Laryngoscopes

Gaurav Gupta, Kamal Bagdi, Ranjeet Singh Virk, Ashish Garg, Isha Gupta


Patients with cervical spine disease/trauma with intact or partially intact neurological status requiring endotracheal intubation present as special cases of difficult airway. Securing the airway in such patients can be a difficult task for any anaesthesiologist especially during emergency situations. Failure to immobilize the neck during tracheal intubation in patients with cervical spine injuries can result in devastating neurological outcome. The purpose of this study was to compare the difficulty during orotracheal intubation in patients with cervical spine immobilization (using Manual In-line Axial Stabilization) in two groups using Macintosh or TruView laryngoscopes utilizing the Intubation Difficulty Scale (IDS), to compare the duration and success rate of intubation in the two groups. Sixty consenting patients scheduled for elective surgery and requiring general anaesthesia with orotrachealintubation were entered into the study and were equally randomized to undergo intubation using a Macintosh or TruView EVO2TM laryngoscope with the cervical spine immobilized using Manual In-line Axial Stabilization (MILS). A single attempt at laryngoscopy was given. Time taken for intubation was observed. Duration exceeding 120 s was considered as a failure. Parameters of IDS score were observed to compare the difficulty between the two groups. IDS score was significantly lower in TruView Group. All patients in the Macintosh Group were intubated successfully while 24(80%) patients in TruView Group could be intubated successfully. The average duration of intubation was significantly longer in the TruView Group compared to Macintosh Group. TruView laryngoscope provided a significantly better glottic view and required less optimizing maneuvers. Duration of intubation was prolonged with TruView owing to significantly more number of intubations, also more time in obtaining glottic view causing failure of intubation in some cases. TruView laryngoscope required more time but reduced the intubation difficulty and was less successful within the stipulated time for laryngoscopy than Macintosh laryngoscope for intubation in patients with cervical spine immobilization.


TruView laryngoscopes,cervical spine injuries ,Macintosh

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Todd MM. Cervical spine anatomy and function for the anesthesiologist. Can J Anesth. 2001;48:R1–R5.

Penning L. Normal movements of the cervical spine. Amer J Roentgenology. 1978;130:317–326.

Majernick TG, Bieniek R, Houston JB, Hughes HG. Cervical spine movement during orotracheal intubation. Ann Emerg Med.1986;15:417–420.

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 cineflouroscopic study of subjects without cervical abnormality. Anesthesiology. 1996;85:26–36.

Karbi OA, Caspari DA, Tator CH. Extrication, immobilization and radiologic investigation of patients with cervical spine injuries.Can Med Assoc J. 1988;139:617–621.

Bohlman HH. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg. 1979;61:1119–1142.

Podolsky S, Baraff LJ, Simon RR, Hoffman JR, Larmon B, Ablon W. Efficiency of cervical spine immobilization methods. J Trauma.1983;23:461–465.

Hastings RH, Marks JD. Airway management for trauma patients with potential cervical spine injuries. Anesth Analg.1991;73:471–482.

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;92:201–206.

Brimacombe J, Keller C, Künzel KH, Gaber O, Boehler M, Pühringer F. Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg.2000;91:1274–1278.

Li JB, Xiong YC, Wang L, Fan XH, Li Y, Xu Y, et al. An evaluation of the TruView EVO2 laryngoscope. Anesthesia. 2007;62:940–943.

Truphatek International Ltd. TruView EVO2 optical view larygoscope. Available at www.truphatek.com

Gotou M, Inoue T. Application of the TruView EVO2 optical laryngoscope to patients with cervical spine disease. J Anesthesia.2007;21:295–296.

Matsumoto S, Asai T, Shingu K. Truview video laryngoscopy in patients with difficult airways. Anesth Analg. 2006;103:492–493.

Lieberman N, Hakim AR, Lemberg L, Berkenstadt H. Truview blade improves laryngeal view when compared to Macintosh blade. Anesthesiology. 2003;99:A565.

Maharaj CH, Buckley E, Harte BH, Laffey JG. Endotracheal intubation in patients with cervical spine immobilization: a comparison of Macintosh and airtaq laryngoscopes. Anesthesiology.2007;107:53–59.

Bouget D, Boukobza M, Metzger M, Roy-Camille R, Viars P. Difficult intubation for cervical spine surgery: airway assessment with magnetic resonance imaging. Anesthesiology.1988;69:A725.

Danzel DF, Thomas DM. Nasotracheal intubations in the emergency department. Crit Care Med. 1980;8:677–682.

Giuffrida JG, Bizzari DV, Latteri FS, Berger HC, Schmookler A, Fierro FE. Prevention of major airway complications during anesthesia by intubation of the conscious patient. Anesth

Analg. 1960;39:201–211.

Gold MI, Buechel DR. A method of blind nasal intubation for the conscious patient. Anesth Analg. 1960;39:257–263.

Kapp JP. Endotracheal intubation in patients with fractures of the cervical spine. Technical note. J Neurosurg. 1975;42:731–732.

Messeter KH, Pettersson KI. Endotracheal intubation with the fibre-optic bronchoscope. Anaesthesia. 1980;35:294–298.

Rogers SN, Benumof JL. New and easy techniques for fiberoptic endoscopy-aided tracheal intubation. Anesthesiology.1983;59:569–572.

Hemmer D, Lee TS, Wright BD. Intubation of a child with a cervical spine injury with the aid of a fibreoptic bronchoscope.Anaesth Intensive Care. 1982;10:163–165.

McNamara RM. Retrograde intubation of the trachea. Ann Emerg Med. 1987;16:680–682.

Riou B, Barriot P, Bodenan P, Viars P. Retrograde tracheal intubation in trauma patients. Anesthesiology. 1987;67:A130.

Kress TD, Balasubramanian S. Cricothyrodotomy. Ann Emerg Med. 1982;11:197–201.

McGill J, Clinton JE, Ruiz E. Cricothyrotomy in the emergency department. Ann Emerg Med. 1982;11:361–364.

Jacoby J. Nasal endotracheal intubation by an external visual technic. Anesth Analg. 1970;49:731–739.

Grande CM, Barton RB, Stene JK. Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg. 1988;67:714–715.

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.


Smith CE, Pinchak AB, Sidhu TS, Radesic BP, Pinchak AC, Hagen JF. Evaluation of tracheal intubation difficulty in patients with cervical spine immobilization: fiberoptic (WuScope) versus conventional lavngoscopy. Anesthesiology. 1999;91:1253–1259.

Agrò F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth. 2003;90:705–706.


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