Comparative study of fiberoptic guided versus intubating laryngeal mask airway assisted awake orotracheal intubation in patients with unstable cervical spine.

BACKGROUND: A safe airway technique minimizes intubation-associated cervical-spine movement and consequent neurological injury in patients with unstable cervical spine (UCS). Awake fiberoptic-guided intubation (FGI) is preferred in patients with UCS. Alternatively, intubating laryngeal mask airway assisted intubation (ILMA-AI) can be performed both during elective and emergency, requires less expertise and is cost-effective. This study evaluated cervical-spine movement during FGI and ILMA-AI in patients with UCS.

METHODS: This was a parallel-group randomized controlled trial performed at a tertiary neurosciences hospital. Thirty-two patients with UCS scheduled for corrective surgery were allocated equally to receive FGI or ILMA-AI according to centralized computer-generated randomization. Primary outcome measure was cervical-spine movement as assessed using fluoroscopy at C1/2 level during intubation. Secondary outcomes were movement at C2/3 and new-onset motor deficit after intubation.

RESULTS: All the sixteen patients in each group were successfully intubated and their data was analyzed. No significant difference in angles (indicating cervical spine movement) was observed at both C1/2 and C2/3 levels between FGI and ILMA-AI groups at various time points studied (P>0.05). No new-onset motor deficit was observed after intubation in both groups. One patient in FGI group developed desaturation during intubation while four patients in ILMA-AI group developed postoperative sore-throat.

CONCLUSIONS: Similar degree of angulations was observed at various time-points during awake FGI and awake ILMA-AI at C1/2 and C2/3 spinal levels in patients with UCS. No patient developed new-onset motor deficits. ILMA can serve as a suitable alternative to fiberoptic-scope for awake intubation in cervical-spine instability.