Airtraq® vs. fibreoptic intubation in patients with an unstable cervical spine fracture: A neurophysiological study. (April 2020)

• Record Type: Journal Article
• Authors: Schoettker, Patrick; Pérez Arias, Ana; Pralong, Etienne; Duff, John Michael; Fournier, Nicolas; Bathory, Istvan
• Is Part Of: Trends in anaesthesia and critical care. Volume 31(2020)
• Page Start: 28
• Page End: 34
• Publication Date: 2020-04
• Subjects: Cervical fracture 1 -- Intubation techniques 2 -- SSEP 3 -- Videolaryngoscope 4 -- Fiberscope 5; Anesthesia -- Periodicals; Critical care medicine -- Periodicals; Anesthesia in traumatology -- Periodicals; Anesthesia -- Case studies -- Periodicals; 617.9605
• DOI: 10.1016/j.tacc.2020.01.001
• Languages: English
• ISSNs: 2210-8440

Abstract

Abstract: Background: Fibreoptic intubation is described as the preferred technique for the non-urgent airway control in patients with an unstable cervical spine injury. Indirect laryngoscopes offer promising advantages, but their safety and impact on cervical spine movement is still discussed. Aim: We compared the incidence of significant neurophysiologic modifications associated with tracheal intubation performed randomly by an Airtraq® videolaryngoscope contrasted with asleep fibreoptic intubation in 40 patients with a traumatic unstable cervical spine fracture immobilized by a moulded cervical collar and scheduled for elective surgery. Methods: Somatosensitive evoked potentials (SSEPs) monitoring was performed at four stages: before airway management (baseline), during facemask ventilation, during intubation and after definitive positioning for surgery. Time, ease of intubation, number of attempts and grade view laryngoscopy were also recorded. Results: Significant neurophysiological modifications were detected in one patient in each group during intubation. They were also identified during ventilation in 1/40 patients and 13/40 patients after positioning. Intubation times were significantly shorter when performed by an Airtraq® (median [25th;75th] 45 s [41;54]) than by fiberscope (124 [88;152]), (p < 0.001), and no external manoeuvres were required (vs 18/20 fiberscope group). None of the patients with significative SSEPs modification presented a worsening of their neurological status at discharge. Conclusion: Tracheal intubation with an Airtraq® appears to be a viable alternative to fibreoptic intubation in patients with a traumatic cervical spine fracture and immobilized by a moulded cervical collar. Time necessary to secure an airway in these patients is significantly shorter with the Airtraq®.