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GENERAL ARTICLES

Segmental Cervical Spine Movement with the Intubating Laryngeal Mask During Manual In-Line Stabilization in Patients with Cervical Pathology Undergoing Cervical Spine Surgery

S. Kihara, MD^*, S. Watanabe, MD, PhD^*, J. Brimacombe, MB ChB, FRCA, MD, N. Taguchi, MD^*, Y. Yaguchi, MD^*, and Y. Yamasaki, MD^*

*Department of Anaesthesia, Pain Clinic, and Clinical Toxicology, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan; and Department of Anaesthesia and Intensive Care, University of Queensland, Cairns Base Hospital, The Esplanade, Cairns, Australia

Address correspondence to Dr. J. Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to 100236,2343{at}compuserve.com

We quantified the extent and distribution of segmental cervical movement produced by the intubating laryngeal mask (ILM) during manual in-line stabilization in 20 anesthetized patients with cervical pathology undergoing cervical spine surgery. All patients had neurological symptoms preoperatively. The ILM was inserted with the head and neck in the neutral position. Intubation was facilitated by transillumination of the neck with a lightwand. Cervical movement was recorded with single-frame lateral radiographic images taken 1) immediately before induction (baseline); 2) during ILM insertion (insertion); 3) when transillumination was first seen at the cricothyroid membrane (intubation A); 4) when the tube was being advanced into the trachea (intubation B); and 5) during ILM removal (removal). Radiographic images were digitized and the degree of flexion/extension and posterior movement measured for the occiput (C0) through to C5. During ILM insertion, C0-5 were flexed by an average of 1–1.6 degrees (all P < 0.05). During intubation A/B, C0-4 were flexed by an average of 1.4–3.0 degrees (all P < 0.01), but C5 was unchanged. During ILM removal, C0-3 were flexed by an average of 1 degree (all: P < 0.05), but C3-5 were unchanged. During insertion and intubation A/B, C2-5 were displaced posteriorly by an average of 0.5–1.0 mm (all: P < 0.05). During removal, there was no change at C1-5. Neurological symptoms improved in all patients. We conclude that the ILM produces segmental movement of the cervical spine despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability.

Implications: The intubating laryngeal mask produces segmental movement of the cervical spine, despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability.

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