Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq(®) , Macintosh and McCoy laryngoscopes

Anaesthesia. 2015 Apr;70(4):452-61. doi: 10.1111/anae.12956. Epub 2014 Dec 5.

Abstract

Concern that laryngoscopy and intubation might create or exacerbate a spinal cord injury has generated extensive research into cervical spinal movement during laryngoscopy. We performed a randomised trial on six cadavers, using three different laryngoscopes, before and after creating a type-2 odontoid peg fracture. Our primary outcome measure was the change in the space available for the spinal cord at the C1/2 segment measured by cinefluoroscopy. Tracheal intubation was performed using a minimal view of the glottis, a bougie, and manual in-line stabilisation. In a cadaveric model of type-2 odontoid fracture, the space available for the cord was preserved in maximum flexion and extension, and changed little on laryngoscopy and intubation.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atlanto-Axial Joint / physiopathology*
  • Cadaver
  • Cervical Vertebrae / physiopathology
  • Female
  • Fluoroscopy / methods
  • Head Movements / physiology
  • Humans
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Laryngoscopes*
  • Laryngoscopy
  • Movement / physiology*
  • Odontoid Process / diagnostic imaging
  • Odontoid Process / injuries
  • Spinal Cord / pathology
  • Spinal Cord / physiopathology
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / pathology
  • Spinal Fractures / physiopathology*