A Randomized Comparative Study Between Airtraq and McCoy for Intubation in Patients with Cervical Spine Injury

Authors

  •   Srilata Moningi Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana
  •   Dilip Kumar Kulkarni Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana
  •   Gopinath Ramachandran Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana
  •   Anandram Aluri Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana
  •   Sudheer Kumar Atluri Department of Anaesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana
  •   Anshul Yadav Department of Anaesthesia, Medanta, Gurgaon, Haryana

Keywords:

Airtraq, cervical spine injury, immobilization, McCoy laryngoscope

Abstract

Background: This study was done to compare Airtraq and McCoy for intubation characteristics and hemodynamic parameters following endotracheal intubation in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery. Materials and Methods: After Institutional Ethical Committee approval, a prospective randomized comparative study was designed on forty American Society of Anesthesiologists I and II patients involving single level ACDF surgery. Following standard anesthesia protocol and manual in-line stabilization applied along with a cervical collar or pin traction for immobilization, tracheal intubation was performed either with Airtraq or McCoy. The time taken for intubation, intubation difficulty score (IDS), comfort grading, and hemodynamic parameters were noted following intubation. The categorical data were compared using Chi-square test and the continuous variables were compared between the groups using paired sample t-test. Repeated ANOVA was tested for hemodynamic data at each measurement time point and Tukey post hoc was used for within the group comparisons at different timings following intubation. Results: The mean intubation time was 24.41 ± 14.8 s in Airtraq group (Group A) which was statistically significant compared to McCoy group (Group M) 38.96 ± 15.55 s (P = 0.001). The IDS and comfort grading was statistically significant in Group A compared to Group M. The changes in hemodynamic vitals following intubation were comparable in both the groups. Conclusion: Airtraq improves the grade of glottic visualization with minimal assistance. It also minimized the time taken for intubation had stable hemodynamics with increased comfort to the anesthetist.

Downloads

Download data is not yet available.

Downloads

Published

2016-01-01

How to Cite

Moningi, S., Kulkarni, D. K., Ramachandran, G., Aluri, A., Atluri, S. K., & Yadav, A. (2016). A Randomized Comparative Study Between Airtraq and McCoy for Intubation in Patients with Cervical Spine Injury. Karnataka Anaesthesia Journal, 2(1), 7–13. Retrieved from https://karnatakaanesthesiajournal.in/index.php/kaj/article/view/139112

Issue

Volume 2, Issue 1, January - March 2016

Section

Original Articles

References

Gercek E, Wahlen BM, Rommens PM. In vivo ultrasound real-time motion of the cervical spine during intubation under manual in-line stabilization: A comparison of intubation methods. Eur J Anaesthesiol 2008;25:29-36.

Prasarn ML, Conrad B, Rubery PT, Wendling A, Aydog T, Horodyski M, et al. Comparison of 4 airway devices on cervical spine alignment in a cadaver model with global ligamentous instability at C5-C6. Spine (Phila Pa 1976) 2012;37:476-81.

Durga P, Kaur J, Ahmed SY, Kaniti G, Ramachandran G. Comparison of tracheal intubation using the Airtraq(®) and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury. Indian J Anaesth 2012;56:529-34.

Birtwell WC, Soroff HS, Giron F, Thrower WB, Ruiz U, Deterling RA Jr.Synchronous assisted circulation. Can Med Assoc J 1966;95:652-64.

Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, et al. The intubation difficulty scale (IDS): Proposal and evaluation of a new score characterizing the complexity of endotracheal intubation.Anesthesiology 1997;87:1290-7.

Powell RM, Heath KJ. Quadraplegia in a patient with an undiagnosed odontoid peg fracture. The importance of cervical spine immobilisation in patients with head injuries. J R Army Med Corps 1996;142:79-81.

Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: Historical review and current questions. Ann Emerg Med 2007;50:236-45.

Aziz M. Use of video-assisted intubation devices in the management of patients with trauma. Anesthesiol Clin 2013;31:157-66.

Tolon MA, Zanaty OM, Shafshak W, Arida EE. Comparative study between the use of Macintosh laryngoscope and Airtraq in patients with cervical spine immobilization. Alexandria J Med 2012;48:179-85.

Arino J, Velasco J, Civantos G, Martinez O, Lopez-Timoneda F.Comparison of the Airtraq and McCoy laryngoscopes for endotracheal intubation: 19AP5-4. Eur J Anaesthesiol 2008;25:247-8.

Sherren PB, Kong ML, Chang S. Comparison of the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway in a difficult airway with manual in-line stabilisation: A cross-over simulation-based study. Eur J Anaesthesiol 2013;30:544-9.

Kaki AM, Almarakbi WA, Fawzi HM, Boker AM. Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students’ hands: A manikin study. Saudi J Anaesth 2011;5:376-81.

Castañeda Pascual M, Batllori M, Gómez-Ayechu M, Iza J, Unzué P, Martín MP. Airtraq optical laryngoscopy. An Sist Sanit Navar 2009;32:75-83.

Baciarello M, Zasa M, Manferdini ME, Tosi M, Berti M, Fanelli G.The learning curve for laryngoscopy: Airtraq versus Macintosh laryngoscopes. J Anesth 2012;26:516-24.

Di Marco P, Scattoni L, Spinoglio A, Luzi M, Canneti A, Pietropaoli P, et al. Learning curves of the Airtraq and the Macintosh laryngoscopes for tracheal intubation by novice laryngoscopists: A clinical study.

Anesth Analg 2011;112:122-5.

Amor M, Nabil S, Bensghir M, Moussaoui A, Kabbaj S, Kamili ND, et al. A comparison of Airtraqâ„¢ laryngoscope and standard direct laryngoscopy in adult patients with immobilized cervical spine. Ann Fr Anesth Reanim 2013;32:296-301.

Chalkeidis O, Kotsovolis G, Kalakonas A, Filippidou M, Triantafyllou C, Vaikos D, et al. A comparison between the Airtraq and Macintosh laryngoscopes for routine airway management by experienced anesthesiologists: A randomized clinical trial. Acta Anaesthesiol Taiwan 2010;48:15-20.

Arslan ZI, Yildiz T, Baykara ZN, Solak M, Toker K. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: A comparison of Airtraq and LMA CTrach devices. Anaesthesia 2009;64:1332-6.

Ali QE, Das B, Amir SH, Siddiqui OA, Jamil S. Comparison of the Airtraq and McCoy laryngoscopes using a rigid neck collar in patients with simulated difficult laryngoscopy. J Clin Anesth 2014;26:199-203.

Gellerfors M, Larsson A, Svensén CH, Gryth D. Use of the Airtraq® device for airway management in the prehospital setting – A retrospective study. Scand J Trauma Resusc Emerg Med 2014;22:10.

Amathieu R, Combes X, Abdi W, Housseini LE, Rezzoug A, Dinca A, et al. An algorithm for difficult airway management, modified for modern optical devices (Airtraq laryngoscope; LMA CTrachâ„¢): A 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery. Anesthesiology 2011;114:25-33.

Hirabayashi Y, Hoshuijima H, Kuratani N. Airtraq for difficult airways: A meta-analysis of randomized controlled trials. Masui 2013;62:879-85.

Abdullah HR, Li-Ming T, Marriott A, Wong TG. A comparison between the Bonfils Intubation Fiberscope and McCoy laryngoscope for tracheal intubation in patients with a simulated difficult airway. Anesth Analg 2013;117:1217-20.

Srilata M, Jayaram K, Kulkarni DK, Maddala Appala Narasimha R, Wudaru S, Ramachandran G. Airtraq and pediatric cervical spine surgery. J Neurosurg Anesthesiol 2015;27:7980.

Dhonneur G, Abdi W, Ndoko SK, Amathieu R, Risk N, El Housseini L, et al. Video-assisted versus conventional tracheal intubation in morbidly obese patients. Obes Surg 2009;19:1096-101.

Wainscott MB. Lighting the way: A systematic review of cervical spine motion with emphasis on lightwand intubation technique; 2011. Available from: (https://www.yumpu.com/en/document/view/46270475/lightingtheway-a-systematic-review-of-cervicalspine-motion-/77). [Last accessed on 2016 Apr 29].

Hindman BJ, Santoni BG, Puttlitz CM, From RP, Todd MM. Intubation biomechanics: Laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes. Anesthesiology 2014;121:260-71.

McElwain J, Laffey JG. Comparison of the C-MAC®, Airtraq®, and Macintosh laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization. Br J Anaesth 2011;107:258-64.

Putz L, Dangelser G, Constant B, Jamart J, Collard E, Maes M, et al. Prospective trial comparing Airtraq and Glidescope techniques for intubation of obese patients. Ann Fr Anesth Reanim 2012;31:421-6.

Maharaj CH, Costello JF, Harte BH, Laffey JG. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia 2008;63:182-8.

Bilgin H, Bozkurt M. Tracheal intubation using the ILMA, C-Trach or McCoy laryngoscope in patients with simulated cervical spine injury.Anaesthesia 2006;61:685-91.

McCoy EP, Mirakhur RK, McCloskey BV. A comparison of the stress response to laryngoscopy. The Macintosh versus the McCoy blade. Anaesthesia 1995;50:943-6.