• Prok Laosuwan, Athitarn Earsakul, Numphung Numkarunarunrote, Jongkonnee Khamjaisai, and Somrat Charuluxananan.
• J Med Assoc Thai. 2015 Jan 1;98 Suppl 1:S63-9.

BackgroundIntubation in patients with suspected cervical spine injury must be cautiously performed to avoid any further neurologic trauma. Several intubation techniques have been introduced to minimize cervical spine motion such as the use of the videolaryngoscope.ObjectiveThe present study aims to compare the movement of the cervical spine during intubation by using McGrath series 5 videolaryngoscope (MGL) and that of the conventional Macintosh laryngoscope from cinefluoroscopic imaging.Material And MethodTwenty-two patients undergoing elective orthopedic surgery that did not involve cervical spine procedure and required general anesthesia were recruited into the study. All patients were randomized either to have intubation with MGL (n = 11) or Macintosh laryngoscope (n = 11) in a neutral position with manual in-line stabilization (MILS). The primary outcome was the cervical vertebral angle changes pre- and post-intubation, measured by cinefluoroscopy. The number of intubation attempts, the laryngoscopic view, the time to intubation, and the incidence ofany complications were recorded as well.ResultsEleven patients were included in each group without any exclusion from the study. The cervical vertebral angle changes pre- and post-intubation with the MGL was less than with the Macintosh laryngoscope at C3/4 (2.00 vs. 4.27 degrees, respectively; p-value = 0.034) and the cumulative changes of all cervical spine levels (9.18 vs. 17.18 degrees, respectively; p-value = 0.017). However, the time to intubation with the MGL was longer (35.07 vs. 23.21 seconds, p-value = 0.004), the laryngoscope view was better. There were no statistically significant differences in the intubation success rate, the number of attempts, and the incidence of complications.ConclusionOrotracheal intubation with MGL provided less cervical spine motion and improved visualization of the vocal cords, without causing adverse consequences as compared with Macintosh laryngoscope and MILS.

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