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

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

Abstract

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.

Keywords

TruView laryngoscopes,cervical spine injuries ,Macintosh

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