A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation

Abstract

BACKGROUND: In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS: In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation. RESULTS: Cervical spine motion at the occiput-C1 segment was 5.6 degrees (4.3) and 9.3 degrees (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8 degrees [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1 degrees [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2 degrees [-2.8 to 2.5]; P = .795 in the C2-C5 segment). CONCLUSIONS: The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization.