Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope

Abstract

The question of which is the optimum technique to intubate the trachea in a patient who may have a cervical(C)-spine injury remains unresolved. We compared, using fluoroscopic video, C-spine motion during intubation for Macintosh 3 blade, GlideScope, and Intubating Lighted Stylet, popularly known as the Lightwand or Trachlight. Thirty-six healthy patients were randomized to participate in a crossover trial of either Lightwand or GlideScope to Macintosh laryngoscopy, with in-line stabilization. C-spine motion was examined at the Occiput-C1 junction, C1-2 junction, C2-5 motion segment, and C5-thoracic motion segment during manual ventilation via bag-mask, laryngoscopy, and intubation. Time to intubate was also measured. C-spine motion during bag-mask ventilation was 82% less at the four motion segments studied than during Macintosh laryngoscopy (P < 0.001). C-spine motion using the Lightwand was less than during Macintosh laryngoscopy, averaging 57% less at the four motion segments studied (P < 0.03). There was no significant difference in time to intubate between the Lightwand and the Macintosh blade. C-spine motion was reduced 50% at the C2-5 segment using the GlideScope (P < 0.04) but unchanged at the other segments. Laryngoscopy with GlideScope took 62% longer than with the Macintosh blade (P < 0.01). Thus, the Lightwand (Intubating Lighted Stylet) is associated with reduced C-spine movement during endotracheal intubation compared with the Macintosh laryngoscope.