Document Detail


Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation.
MedLine Citation:
PMID:  19104166     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Manual in-line stabilization (MILS) is recommended during direct laryngoscopy and intubation in patients with known or suspected cervical spine instability. Because MILS impairs glottic visualization, the authors hypothesized that anesthesiologists would apply greater pressure during intubations with MILS than without. METHODS: Nine anesthetized and pharmacologically paralyzed patients underwent two sequential laryngoscopies and intubations, one with MILS and one without, in random order. A transducer array along a Macintosh 3 laryngoscope blade continuously measured applied pressures, and glottic view was characterized. RESULTS: With MILS, glottic visualization was worse in six patients, and intubation failure occurred in two of these six patients. Maximum laryngoscope pressure at best glottic view was greater with MILS than without (717 +/- 339 mmHg vs. 363 +/- 121 mmHg, respectively; n = 8; P = 0.023). Other measures of pressure application also indicated comparable increases with MILS. CONCLUSION: Pressures applied to airway tissues by the laryngoscope blade are secondarily transmitted to the cervical spine and result in cranio-cervical motion. In the presence of cervical instability, impaired glottic visualization and secondary increases in pressure application with MILS have the potential to increase pathologic cranio-cervical motion.
Authors:
Brandon G Santoni; Bradley J Hindman; Christian M Puttlitz; Julie B Weeks; Nathaniel Johnson; Mazen A Maktabi; Michael M Todd
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  110     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-23     Completed Date:  2009-01-22     Revised Date:  2009-10-28    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  24-31     Citation Subset:  AIM; IM    
Affiliation:
Department of Mechanical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Follow-Up Studies
Humans
Intubation, Intratracheal / instrumentation*,  methods*
Laryngoscopes*
Laryngoscopy / methods*
Male
Middle Aged
Pressure
Transducers, Pressure
Comments/Corrections
Comment In:
Anesthesiology. 2009 Jan;110(1):6-7   [PMID:  19104160 ]
Anesthesiology. 2009 Nov;111(5):1158; author reply 1159-60   [PMID:  19858879 ]
Anesthesiology. 2009 Nov;111(5):1158-9; author reply 1159-60   [PMID:  19858878 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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