A Comparison of Cervical Spine Motion During Orotracheal Intubation with the Trachlight® or the Flexible Fiberoptic Bronchoscope

BACKGROUND: Tracheal intubation of an unstable cervical spine (c-spine) patient with the flexible fiberoptic bronchoscope (FOB) is thought to minimize c-spine movement but may be technically difficult in certain patients. Intubation using a luminous stylet, such as the Trachlight (R) (TL), also produces minimal motion of the c-spine and may be an interesting alternative technique for patients with an unstable c-spine. In this study, we compared the cervical motion caused by the TL and the FOB during intubation. METHODS: Twenty patients with a normal c-spine undergoing general anesthesia, including neuromuscular blockade, for a neuroradiologic intervention were included in a prospective, randomized, controlled, nonblinded, crossover trial. Each patient was tracheally intubated sequentially with the TL and the FOB in a randomized order. Manual in-line stabilization was applied by an assistant during intubation. The motions produced by intubation from the occiput (C0) to C5 were recorded in the sagittal plane using continuous cinefluoroscopy. For movement analysis, the recordings were divided into four stages: "baseline" before intubation began; "introduction" of the intubation device; "intubation" (passage of the tube through the vocal cords); and "removal" of the device. For each intubating device, the average maximal segmental motion observed in every patient at any stage or cervical segment was calculated and compared using Student's t-test. The time required to intubate with each device was also compared. RESULTS: There was no significant difference in the mean maximum segmental motion produced during intubation with the TL versus the FOB (12 degrees +/- 6 degrees vs 11 degrees +/- 5 degrees; P = 0.5). Segmental movements occurred predominantly at the C0-1 and C1-2 levels, and maximal movements were observed during the introduction stage in 18/20 patients for both devices. Intubation took less time with the TL (34 17 vs 60 +/- 15s, P < 0.001). CONCLUSION: In patients under general anesthesia with neuromuscular blockade and manual in-line stabilization, we found no difference in the segmental c-spine motion produced during endotracheal intubation using the FOB and the TL.