Nalinee Kovitwanawong, Lertluk Suwansukho, Teeranan Laohawiriyakamol and Thavat Chanchayanon
Background: Cervical spine movement does occur during intubation and in patients with cervical spine injuries; the result can have devastating neurologic outcomes. Video laryngoscopes provide a better view of the glottis and less cervical spine movement. Objective: The purpose of this study is a comparison of cervical spine motion during tracheal intubation between the GlideScope video laryngoscopy and the Pentax Airway Scope. The primary outcome is the difference in cervical spine motion. The cervical spine motion was recorded using fluoroscopic video and the angular displacement of the spine was measured by a radiologist. The secondary outcome is the hemodynamic changes after intubation. Methods: Into Pentax Airway Scope and GlideScope video laryngoscopy groups, we randomly allocated two hundred and one patients who underwent elective non-cardiac surgery and require general anesthesia with tracheal intubation. All patients underwent general anesthesia with the same induction medications, muscle relaxant and narcotics. During airway maneuvers, a fluoroscopy was used to record cervical spine movements from the occiput down to C5 level. Vital signs were recorded after successful intubation. All images were measured by the radiologist consultant. Using the classic AutoCAD program and the angles between adjacent levels were calculated and shown as a number. Results: The Pentax Airway Scope and GlideScope induced the greatest cervical spine movement in the C1-C2 segments, during each stage of the laryngoscopies. Cervical spine motion was not statistically different using either video laryngoscope at the five segments studied. The hemodynamic changes after intubation showed after the first and second minutes and there were significantly less systolic blood pressure and diastolic blood pressure changes in the Pentax group. Conclusion: Cervical spine movement during tracheal intubation is not significant difference between the Pentax Airway Scope and the GlideScope.