• Kaustuv Dutta, Kamath Sriganesh, Dhritiman Chakrabarti, Nupur Pruthi, and Madhusudan Reddy.
• Departments of Neuroanaesthesia and Neurocritical Care.
• J Neurosurg Anesthesiol. 2020 Jul 1; 32 (3): 249-255.

BackgroundCervical spine movement during intubation with direct laryngoscopy can predispose to new-onset neurological deficits in patients with cervical spine instability. While fiberoptic-guided intubation (FGI) is mostly preferred in such patients, this is not always possible. Videolaryngoscopy results in less cervical spine movement than direct laryngoscopy and may be an alternative to FGI in patients with cervical spine instability. The objective of this study was to compare cervical spine movement during awake FGI with those during awake McGrath videolaryngoscope-guided intubation (VGI) in patients undergoing surgery for cervical spine instability.MethodsForty-six adult patients with upper cervical spine instability scheduled for stabilization surgery were randomized to awake FGI or awake VGI. Cervical spine movement during intubation was assessed by changes in lateral fluoroscopic-measured angles (α and β at C1/C2 and C3 levels, respectively) at 3 time points: T1, preintubation; T2, during intubation; T3, postintubation. Motor power was assessed before and after intubation.ResultsPatient demographics and airway characteristics were similar between the 2 groups. Cervical spine motion (in degrees) during intubation was significantly greater with VGI than FGI at C1/C2 (T3-T1, -8.02±8.11 vs. -1.47±3.31; P<0.001) but not at C3 (T3-T1, -2.17±5.16 vs. -1.85±3.29; P=0.960). No patient developed new-onset motor deficits following intubation in either group.ConclusionsCompared with FGI, VGI results in a greater degree of cervical spine movement at C1/C2 but not at C3.

18 keywords...

hide…