Comparative study between the use of Macintosh Laryngoscope and Airtraq in patients with cervical spine immobilization

Abstract

Background: Airway management is a major responsibility for anesthetist. This study was carried out to evaluate and compare the efficacy of Airtraq (AL) and Macintosh Laryngoscopes (ML) in intubating patients with cervical spine immobilization using manual inline axial stabilization technique (MIAS).
Methods: This randomized controlled study was carried out in Alexandria Main University Hospital on 40 adult ASA I and II patients after written informed consent and approval of the ethical committee, randomly categorized into two equal groups. All patients were subjected to same
anesthetic protocol. Group I patients were intubated using AL and group II patients were intubated using ML. Hemodynamic measurements and oxygen saturation were recorded. Intubation criteria for both groups including (duration of intubation procedure, number of attempts, number of optimization maneuvers, Cormack and Lehane grade at laryngoscopy, Intubation Difficulty Scale score (IDS), rate of successful placement of endotracheal tube, neck mobility during laryngoscopy and intubation complications were recorded. Data statistically analyzed using SPSSR software using (t and v2 tests) and P < 0.05 considered significant. Results: There was statistically significant increase in both heart rate and mean arterial blood pressure values following intubation in ML group than AL, oxygen saturation showed no significant difference between the two groups. Duration of intubation was statistically significant longer in ML group and needed more optimization maneuvers than the AL group, while for the number of intubation attempts; there was no statistically significant difference between the two groups. Both the Cormack and Lehane grading and IDS score values have shown statistically significant higher values in ML group.

Conclusion: The Airtraq Laryngoscope offers a new approach for the management of difficult airway like patients with potential cervical spine injury, it is fast, easy to use, gets an easy view of the larynx without moving the cervical spines or causing hemodynamic stimulation.