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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.

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