Videolaryngoscopic Intubation in Cervical Immobilization
Trial question
What is the role of applying only posterior piece in patients wearing a cervical collar during videolaryngoscopic intubation?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
78.0% female
22.0% male
N = 102
102 patients (80 female, 22 male).
Inclusion criteria: adult patients with cervical immobilization scheduled for elective neurointervention under general anesthesia.
Key exclusion criteria: upper airway disease; cervical spine disease; history of surgical treatment of the upper airway or cervical spine; high risk of aspiration; coagulopathy; dental injury.
Interventions
N=51 intubation in posterior-only immobilization (applying only the posterior piece of the cervical collar).
N=51 intubation in anterior-posterior immobilization (applying both the anterior and posterior pieces of the cervical collar).
Primary outcome
Cervical spine motion during intubation at occiput-C1 segment
10.8
9.6
10.8 degrees
8.1 degrees
5.4 degrees
2.7 degrees
0.0 degrees
Intubation in posterior-only
immobilization
Intubation in anterior-posterior
immobilization
No significant
difference ↔
No significant difference in cervical spine motion during intubation at occiput-C1 segment (10.8 degrees vs. 9.6 degrees; MD 1.2, 97.5% CI -0.7 to 3).
Secondary outcomes
No significant difference in cervical spine motion during intubation at C1-C2 segment (5.6 degrees vs. 4.7 degrees; MD 1, 97.5% CI -0.6 to 2.6).
No significant difference in cervical spine motion during intubation at C2-C5 segment (1.2 degrees vs. 1.5 degrees; MD -0.3, 97.5% CI -2.2 to 1.7).
Significant decrease in cervical spine angle at intubation at occiput-C1 segment (38.9 degrees vs. 42 degrees; MD -3.2, 97.5% CI -5.9 to -0.5).
Conclusion
In adult patients with cervical immobilization scheduled for elective neurointervention under general anesthesia, intubation in posterior-only immobilization was not superior to intubation in anterior-posterior immobilization with respect to cervical spine motion during intubation at occiput-C1 segment.
Reference
Woo-Young Jo, Jae-Hyun Choi, Jay Kim et al. Cervical spine motion during videolaryngoscopic intubation using a Macintosh-style blade with and without the anterior piece of a cervical collar: a randomized controlled trial. Can J Anaesth. 2024 Oct 14. Online ahead of print.
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