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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 November;83(11):1152-60

DOI: 10.23736/S0375-9393.17.11913-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Cervical spine motion during tracheal intubation with King Vision™ video laryngoscopy and conventional laryngoscopy: a crossover randomized study

Mohamed R. EL-TAHAN 1, 2, Samah EL KENANY 2, Alaa M. KHIDR 1, Abdulmohsen A. AL GHAMDI 1, Ahmed M. TAWFIK 3, Abdullah S. AL MULHIM 4

1 Department of Anesthesiology, King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia; 2 Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura, Egypt; 3 Department of Diagnostic Radiology, College of Medicine, Mansoura University, Mansoura, Egypt; 4 Department of Radiology, King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia


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BACKGROUND: The King Vision™ (KVL) videolaryngoscope with a wide field of view could potentially reduce cervical spine motion during intubation. We aimed to compare the extent of cervical spine movement during laryngoscopy using the KVL and Macintosh laryngoscopes.
METHODS: Following ethical approval, 29 patients with a normal cervical spine requiring general anesthesia and tracheal intubation were randomly subjected to both KVL and Macintosh laryngoscopy in a crossover. Cervical spine motion during each laryngoscopy was radiologically examined by measuring changes in cumulative spine motion and changes from the neutral position in the C0-C5 angles formed by the adjacent vertebrae. Time to tracheal intubation, laryngoscopic view, and ease of intubation were also recorded.
RESULTS: Compared with direct laryngoscopy, the KVL resulted in significantly less movement of the C-spine at the C0-C1, and C3-C4, C4-C5 segments (mean differences: C0-C1: 3.01 ° [95% CI: -4.74° to -1.28°]; C3-C4: 1.81° [95% CI: -3.19° to -0.43°]; C4-C5: -0.88° [95% CI: -1.61° to -0.19°], P<0.02) and cumulative C-spine movement (mean 36.1˚[95% CI 32.72 to 39.51] vs. 44.1˚[95%CI: 39.54 to 48.75]; P=0.001). There was significant movement in the C0-C3 segment from baseline using both devices. Tracheal intubation took longer with KVL (mean difference: 12.7 s [95% CI: 9.15 to 16.13 s]; P=0.001) even though laryngeal visualization was improved (Cormack Lehane Grade I was reported in 100% KVL vs. 65.5% Macintosh laryngoscopies; P=0.001).
CONCLUSIONS: In patients with normal cervical spine, KVL resulted in less extension of the cervical spine than direct laryngoscopy.


KEY WORDS: Cervical vertebrae - Movement - Laryngoscopy

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Publication History

Issue published online: November 17, 2017
Article first published online: June 12, 2017
Manuscript accepted: March 23, 2017
Manuscript revised: April 26, 2017
Manuscript received: January 5, 2017

Cite this article as

El-Tahan MR, El Kenany S, Khidr AM, Al Ghamdi AA, Tawfik AM, Al Mulhim AS. Cervical spine motion during tracheal intubation with King Vision™ video laryngoscopy and conventional laryngoscopy: a crossover randomized study. Minerva Anestesiol 2017;83:1152-60. DOI: 10.23736/S0375-9393.17.11913-9

Corresponding author e-mail

alaakhidr@gmail.com