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A1668
October 22, 2008 9:00 AM - 11:00 AM Room Hall E2-Area F, |
| Use of the Mcgrath® Video Laryngoscope in Unstable Cervical Spine Surgery: A Pilot Investigation |
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Christopher G. Hughes, M.D., Letitia J. Easdown, M.D., Pratik Pandharipande, M.D., Letha Mathews, M.D. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee |
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Introduction Fiberoptic intubations are often performed in patients with anticipated difficult airways and in patients with unstable cervical spine injuries where a post intubation neurological exam is necessary. Recent studies have demonstrated the efficacy of the McGrath® video laryngoscope for tracheal intubation. One advantage of this laryngoscope is that alignment of the three airway axes is theoretically not required since the McGrath® extends the anesthesia provider's line of sight, thus potentially minimizing manipulation of the cervical spine. We undertook this pilot study to evaluate the McGrath® video laryngoscope in patients with unstable cervical spines. Methods Neurosurgical patients presenting for surgical correction of unstable cervical spines were studied over a 6 month interval. Twelve patients (8 females, 4 males) with a mean age of 59 years (range 18-82 years) were included. Of these 12 patients, six required post intubation neurological exams secondary to spinal cord compression and were intubated awake. The other six had significant cervical disease without cord compression and were intubated after general anesthesia was induced. In patients requiring awake intubation, a standardized protocol for airway preparation was employed which consisted of glycopyrrolate (0.2 mg) to decrease secretions followed by 5% viscous and 4% aerosolized lidocaine for airway topicalization. Midazolam, fentanyl, and dexmedetomidine (1 mcg/kg loading dose) were used to provide conscious sedation, and the McGrath® laryngoscope was utilized to intubate the trachea. Once a neurological exam was completed, induction of general anesthesia (GA) was performed per routine standard of care. In patients not requiring awake intubation, GA was induced in the standard manner, and intubation was performed utilizing the McGrath® laryngoscope and manual inline stabilization. Results In the awake group, the trachea was successfully intubated in 5 out of 6 patients on the first attempt with one patient requiring a second attempt due to difficulty passing the endotracheal tube thru the glottic opening. Three of the 6 patients in this group were in halo orthosis for neck stabilization. In these patients, the McGrath® blade and camera stick were disconnected from the handle to facilitate insertion of the blade into the oropharynx. The handle was then reattached, and a view of the glottis was achieved with successful intubation on first attempt in all 3 patients. Overall, the patients tolerated the procedure and post intubation neurological exam very well. In the asleep group, the trachea was successfully intubated in 5 out of 6 patients on the first attempt. Difficulty passing the endotracheal tube thru the glottic opening led to one patient requiring a second attempt. Minimal maneuvering of the McGrath® was required to view the glottis in all 12 patients. Conclusion The McGrath® video laryngoscope can be used successfully in patients with significant cervical spine disease, including those requiring awake tracheal intubations and those with halo orthosis. This pilot project forms the basis of a randomized controlled study looking at patient tolerance, time to intubation, and cervical spine movements with the McGrath® when compared to the fiberoptic bronchoscope. Anesthesiology 2008; 109 A1668 |