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In vivoultrasound real-time motion of the cervical spine during intubation under manual in-line stabilization: a comparison of intubation methods

Gercek, E.*; Wahlen, B. M.; Rommens, P. M.*

European Journal of Anaesthesiology (EJA): January 2008 - Volume 25 - Issue 1 - p 29–36
doi: 10.1017/S0265021507001044
Original Article

Background and objective: In emergency trauma situations, manual in-line stabilization of the cervical spine is recommended to reduce cervical spine movement during intubation. The aim of this study was to compare the effect of manual in-line stabilization during different intubation techniques on three-dimensional cervical spine movements and times to intubation.

Methods: Forty-eight subjects without any history of trauma, inflammatory or degenerative disorder of the cervical spine were randomly grouped, regardless of gender or age. All underwent elective surgery under general anaesthesia. Under manual in-line stabilization, laryngeal intubation with Macintosh laryngoscope, intubating laryngeal mask airway, fibre-endoscopic oral intubation and fibre-endoscopic nasal intubation was performed. During the intubation process, cervical three-dimensional motion was detected by an ultrasound real-time motion analysis system and intubation times were measured.

Results: Cervical spine range in the extension/flexion direction of orolaryngeal intubation with Macintosh (17.57 ± 8.23°) showed significantly more movement than using the intubating laryngeal mask airway (4.60 ± 1.51°) and fibreoptic procedures. Intubating laryngeal mask airway was significantly different than the fibreoptic intubation techniques. There was also a significant difference between oral (3.61 ± 2.25°) nasal and (5.88 ± 3.11°) fibreoptic intubation. Times to intubation all differed significantly (P < 0.05) for the Macintosh laryngoscope (27.25 ± 8.56 s) and for the intubating laryngeal mask airway (16.5 ± 9.76 s). Fibreendoscopic laryngoscopic oral (52.91 ± 56.27 s) and nasal (82.32 ± 54.06 s) intubation resulted in further prolongation of the times to intubation.

Conclusions: The intubating laryngeal mask airway with manual in-line stabilization is a potentially useful adjunct to intubation of patients with potential cervical spine injury, if there are no contraindications to these methods. These results predict that fibreoptic procedures may be a safe instrument for airway management in patients with potential cervical spine injuries; however, the main disadvantages are the longer intubation times.

*Johannes Gutenberg-University of Mainz, Clinic of Trauma Surgery, Mainz

Julius Maximillians-University of Wuerzburg, Clinic of Anaesthesiology, Wuerzburg, Germany

Correspondence to: Erol Gercek, Clinic of Trauma Surgery, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. E-mail:; Tel: +496131172845; Fax: +496131176687

Accepted for publication 18 May 2007

First published online 30 July 2007

© 2008 European Society of Anaesthesiology