RESUMEN
BACKGROUND AND AIMS: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq(®) was evaluated. METHODS: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C) and without rigid cervical collar (group NC). The ease of insertion of Airtraq(®) into the oral cavity, intubation time, intubation difficulty score (IDS) were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. RESULTS: Intubation using Airtraq(®) was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24). The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq(®). The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001). The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s) compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003) and bougie was required in 12 (18.5%) and 4 (6.2%) patients in group C and NC, respectively, to facilitate intubation (P = 0.02). The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. CONCLUSION: Tracheal intubation using Airtraq(®) in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS.
RESUMEN
BACKGROUND: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq(®) provides for easy and successful intubation in the neutral neck position. OBJECTIVE: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. METHODS: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS) were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS) of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. RESULTS: The mean intubation time was 33.27 sec (13.25) for laryngoscopy and 28.95 sec (18.53) for Airtraq (P=0.32). The median IDS values were 4 (interquartile range (IQR) 1-6) and 0 (IQR 0-1) for laryngoscopy and Airtraq, respectively (P=0.007). The median Cormack Lehane glottic view grade was 3 (IQR 2-4) and 1 (IQR 1-1) for laryngoscopy and Airtraq, respectively (P=0.003). The ease of intubation on VAS was graded as 4 (IQR 3-5) for laryngoscopy and 2 (IQR 2-2) for Airtraq (P=0.033). There were two failures to intubate with the Airtraq. CONCLUSION: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury.