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Fluoroscopy-guided combined GlideScope and fiberoptic intubation in patients with compromised cervical spine 2007

General Spine

Ribal S Darwish, MD,
Rizwan Habeeb, MD, Non ASSR Member
Nana S Amiridze, MD, PhD, Non ASSR Member
Douglas Martz, MD, Non ASSR Member

Scientific Paper

Purpose

Several techniques have been proposed to secure the airway in patients with unstable cervical spine (c-spine). The risk of serious complications, including cervical cord injury, during intubation remains high (up to 25%). We propose a fluoroscopy-guided combined technique to increase safety and prevent complications during intubation in patients with compromised c-spine resulting from trauma, cervical stenosis, or underlying lesions.

Methods & Materials

The fluoroscopy-guided combined GlideScope and fiberoptic intubation technique was used in 12 patients with underlying c-spine pathology (8 trauma patients with unstable spine, and 4 patients with c-spine stenosis resulting from degenerative disease).
A cervical collar remained in place during intubation in all trauma cases. The c-spine was evaluated under fluoroscopy in lateral projection before sedation. After adequate preoxygenation, intravenous induction of anesthesia was performed with continuous in-line stabilization of the c-spine. The GlideScope (Saturn Biomedical Systems; Burnaby, BC, Canada) was placed into the mouth to obtain a view of the larynx. A fiberoptic bronchoscope (Olympus Corp.; Lake Success, NY) was passed through the vocal cords, with the endotracheal tube passed over the fiberoptic scope. Visual control of the endotracheal tube passage was obtained through the GlideScope. Intermittent fluoroscopy in lateral projection was used to assure stable alignment and minimal motion of the c-spine throughout the process of intubation, with images recorded at the initial position, position after placement of the GlideScope, after passage of the fiberoptic scope, and after endotracheal tube placement. The data was reviewed retrospectively.

Results

Successful endotracheal intubation was performed in all cases. Alignment of the c-spine remained stable during the procedures. Duration of intubation ranged from 15 to 45 seconds. No intubation-related complications were noted. In several patients, evaluation of the lower cervical spine (C6-C7) was limited in the lateral view.

Conclusion

Fluoroscopy-guided combined GlideScope and fiberoptic intubation is a safe technique that can provide a margin of safety in patients with compromised C-spine and may contribute to the prevention of complications resulting from cervical cord injury during intubation.

References

1. Turkstra TP, Eng M, Eng P, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: A fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg. 2005;101:910-915.

2. Brimacombe J, Keller C, Kunzel KH, et al. Cervical spine motion during airway management: a cinefluoroscopic study of posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91:1274-1278.

3. Hastings RH, Vigil AC, Hanna R, et al. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology. 1995;82:859-869.

4.Agro FM, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth. 2003;90:705-706.

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