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INTUBATION IN UNSTABLE CERVICAL SPINE: ILMA OR MACINTOSH LARYNGOSCOPE?

Department of Anaesthesiology & Intensive care, Maulana Azad Medical College & Lok Nayak Hospital, Delhi 110002, INDIA

INTRODUCTION

In patients with unstable cervical spine, manipulation during airway management may precipitate a neurological disaster.¹ Intubating Laryngeal Mask Airway [ILMA] is best placed with head and neck in neutral position ² and therefore may offer a safer and better option for securing airway in such patients. The present study was undertaken to compare and evaluate the ease of tracheal intubation using ILMA v/s Macintosh Laryngoscope in patients with simulated unstable cervical spine.

METHODS

After Institutional Research Board approval and informed consent, 50 adult patients of ASA physical status I & II of either sex, with essentially normal airway assessment, scheduled to undergo elective surgery under general anaesthetic were chosen. Patients were randomized into 2 groups; Group ML and Group IL.The cervical spine was immobilized by applying manual-in-line stabilization [MLS] and trachea was intubated using Macintosh Laryngoscope in Gp. ML and ILMA in Gp. IL. In all patients, MLS was applied by the same assistant and intubation was performed by the same investigator. The ease of tracheal intubation was assessed using an indigenously devised Intubation Difficulty Scoring System [IDSS] based on 4 parameters; a) number of attempts, b) time taken, c) aids used and d) trauma sustained during intubation.

RESULTS

The ease of intubation as assessed by IDSS was found to be significantly greater in Gp. IL than Gp. ML, with a mean value of 14.4 & 28.8 respectively[p<0.001] Mean time taken for intubation in Gp. ML was greater than in Gp. IL [32secs v/s 25secs], which, however was not found to be statistically significant. Rate of complications like oropharyngeal trauma, was higher in Gp. ML than in Gp. IL [24% v/s 12%].

CONCLUSION

In patients with cervical spine immobilized with MLS, tracheal intubation through ILMA is easier, faster and associated with fewer complications, compared to Macintosh Laryngoscope. ILMA therefore would be a safer technique for intubating patients with an unstable cervical spine.

REFERENCES

1 Wood PR, et al: Anaesthesia; 53:1174–9, 1998[Medline]

2 Brain AIJ, et al: BJA; 79:704–9, 1997

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