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Cervical spine motion: a fluoroscopic comparison of Shikani Optical Stylet® vs Macintosh laryngoscope

[Mouvement de la colonne cervicale : une comparaison fluoroscopique entre le Stylet optique Shikani® et le laryngoscope Macintosh]

Timothy P. Turkstra, MD M Eng FRCPC^*, David M. Pelz, MD FRCPC, A. Allison Shaikh, MD and Rosemary A. Craen, MB BS FRCPC^*

^* From the Department of Anesthesia and Perioperative Medicine, and the
Department of Diagnostic Radiology and Nuclear Medicine, Neuro-radiology Section, University of Western Ontario, London, Ontario, Canada.

Address correspondence to: Dr. T. Turkstra, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Room C3-104, London Health Sciences Centre, 339 Windermere Rd, London, Ontario N6A 5A5, Canada. Phone: 519-685-8500, ext. 35677; Fax: 519-663-2957; E-mail: timothy.turkstra{at}londonhospitals.ca

Purpose: The optimal technique to manage the airway in patients presenting with a potential or documented cervical spine (C-spine) injury remains unresolved. Using fluoroscopic video assessment, C-spine motion during laryngoscopy with a Shikani Optical Stylet® (SOS) was compared to C-spine motion during intubation using a Macintosh blade.

Methods: Twenty-four healthy surgical patients gave written consent to participate in a crossover randomized controlled trial; all patients were subjected to both Macintosh and Shikani laryngoscopy with manual inline stabilization following induction of anesthesia. The C-spine motion was examined at four areas: the occiput-C1 junction, C1-C2 junction, C2-C5 motion segment, and C5-thoracic motion segment. The time required for laryngoscopy was also measured (duration > 120 sec was deemed a failure of the laryngoscopy technique).

Results: On average, C-spine motion was 52% less (P < 0.02) at three of the motion segments studied, occiput-C1, C2-C5, and C5-thoracic when comparing SOS vs Macintosh laryngoscopy. There was no difference between techniques at the C1-C2 segment. Laryngoscopy with SOS (28 ± 17 sec) took longer than with Macintosh blade (17 ± 7 sec), P < 0.01. There were two failures out of 23 using the SOS, vs none with the Macintosh blade.

Conclusion: For patients in whom C-spine movement is undesirable, use of the SOS may limit neck movement, while modestly increasing the time required to intubate, and/or the risk of procedure failure.

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