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. 2024 Jan-Mar;40(1):101-107.
doi: 10.4103/joacp.joacp_89_22. Epub 2023 Jul 29.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes

Kiranpreet Kaur  1 , Rameez Raja  1 , Prashant Kumar  1 , Roop Singh  2 , Sumedha Vashishth  1 , Harshil D Singh  3 , Mamta Bhardwaj  1 , Suresh K Singhal  1
Affiliations

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes

Kiranpreet Kaur et al. J Anaesthesiol Clin Pharmacol. 2024 Jan-Mar.

Abstract

Background and aim: Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq.

Material and methods: A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1.

Results: Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05).

Conclusion: We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Keywords: Cervical vertebrae; general anesthesia; intubation; laryngoscope; laryngoscopy; spine.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Tangents for measuring angle of cervical spine
Figure 2
Figure 2
Baseline tangents and its angle measurement
Figure 3
Figure 3
Tangents and angle calculation after Macintosh laryngoscopy (left) and Airtraq laryngoscopy (right)
Figure 4
Figure 4
Atlanto-occipital distance and tangents for anterior deviation
Figure 5
Figure 5
Comparison of Atlanto-occipital distance between Macintosh and Airtraq
Figure 6
Figure 6
Comparison of anterior deviation between Macintosh and Airtraq
See this image and copyright information in PMC

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