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GENERAL ARTICLES

Cervical Spine Motion: A Fluoroscopic Comparison During Intubation with Lighted Stylet, GlideScope, and Macintosh Laryngoscope

Timothy P. Turkstra, M Eng, P Eng, MD^*, Rosemary A. Craen, MB, BS, FRCPC, FANZCA^*, David M. Pelz, MD, FRCPC, and Adrian W. Gelb, MB, ChB, FRCPC, FRCA^*

Department of *Anesthesia and Perioperative Medicine and Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, Canada

Address correspondence and reprint requests to T. Turkstra, MD, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Rd., London, Ontario, Canada, N6A 5A5. Address e-mail to tturkstra{at}uwo.ca.

The question of which is the optimum technique to intubate the trachea in a patient who may have a cervical(C)-spine injury remains unresolved. We compared, using fluoroscopic video, C-spine motion during intubation for Macintosh 3 blade, GlideScope®, and Intubating Lighted Stylet, popularly known as the Lightwand or Trachlight®. Thirty-six healthy patients were randomized to participate in a crossover trial of either Lightwand or GlideScope to Macintosh laryngoscopy, with in-line stabilization. C-spine motion was examined at the Occiput-C1 junction, C1-2 junction, C2-5 motion segment, and C5-thoracic motion segment during manual ventilation via bag-mask, laryngoscopy, and intubation. Time to intubate was also measured. C-spine motion during bag-mask ventilation was 82% less at the four motion segments studied than during Macintosh laryngoscopy (P < 0.001). C-spine motion using the Lightwand was less than during Macintosh laryngoscopy, averaging 57% less at the four motion segments studied (P < 0.03). There was no significant difference in time to intubate between the Lightwand and the Macintosh blade. C-spine motion was reduced 50% at the C2-5 segment using the GlideScope (P < 0.04) but unchanged at the other segments. Laryngoscopy with GlideScope took 62% longer than with the Macintosh blade (P < 0.01). Thus, the Lightwand (Intubating Lighted Stylet) is associated with reduced C-spine movement during endotracheal intubation compared with the Macintosh laryngoscope.

This article has been cited by other articles:

				A. Robitaille, S. R. Williams, M.-H. Tremblay, F. Guilbert, M. Theriault, and P. Drolet Cervical Spine Motion During Tracheal Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus GlideScope(R) Videolaryngoscopy Anesth. Analg., March 1, 2008; 106(3): 935 - 941. [Abstract] [Full Text] [PDF]

				K. Maruyama, T. Yamada, R. Kawakami, T. Kamata, M. Yokochi, and K. Hara Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope Br. J. Anaesth., January 1, 2008; 100(1): 120 - 124. [Abstract] [Full Text] [PDF]

				T. P. Turkstra, C. C. Harle, K. P. Armstrong, P. M. Armstrong, R. A. Cherry, J. Hoogstra, and P. M. Jones The GlideScope(R)-specific rigid stylet and standard malleable stylet are equally effective for GlideScope(R) use: [Le mandrin rigide specifique au GlideScope(R) et le mandrin flexible standard sont tous deux aussi efficaces pour l'utilisation avec le GlideScope(R)] Can J Anesth, November 1, 2007; 54(11): 891 - 896. [Abstract] [Full Text] [PDF]

				A. Prabhu, D. Wong, S. Chakraborty, E Massicotte, G Tan, and R Cooper 44518 - RADIOGRAPHIC EVALUATION OF CERVICAL SPINE MOVEMENT DURING FLEXIBLE VIDEOBRONCHOSCOPY & LO-PRO GLIDESCOPE; A RANDOMISED CONTROLLED TRIAL Can J Anesth, August 1, 2007; 54(suppl_1): 44518 - 44518. [Abstract] [Full Text] [PDF]

				T. P. Turkstra, D. M. Pelz, A. A. Shaikh, and R. A. Craen Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet(R) vs Macintosh laryngoscope: [Mouvement de la colonne cervicale : une comparaison fluoroscopique entre le Stylet optique Shikani(R) et le laryngoscope Macintosh] Can J Anesth, June 1, 2007; 54(6): 441 - 447. [Abstract] [Full Text] [PDF]

				B. Shippey, D. Ray, and D. McKeown Case series: The McGrath(R) videolaryngoscope - an initial clinical evaluation: [Serie de cas : Le videolaryngoscope McGrath(R) - une premiere evaluation clinique] Can J Anesth, April 1, 2007; 54(4): 307 - 313. [Abstract] [Full Text] [PDF]

				P. M. Jones, T. P. Turkstra, K. P. Armstrong, P. M. Armstrong, R. A. Cherry, J. Hoogstra, and C. C. Harle Effect of stylet angulation and endotracheal tube camber on time to intubation with the GlideScope(R): [Effet de l'angulation du mandrin et de la cambrure de la sonde endotracheale sur le temps requis pour l'intubation avec le GlideScope(R)] Can J Anesth, January 1, 2007; 54(1): 21 - 27. [Abstract] [Full Text] [PDF]

				Lighted Stylet and GlideScope Reduce C-Spine Motion During Intubation Journal Watch Emergency Medicine, October 25, 2005; 2005(1025): 7 - 7. [Full Text]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999