Original contributionA comparison of the bullard laryngoscope versus the flexible fiberoptic bronchoscope during intubation in patients afforded inline stabilization
Introduction
Airway management in patients with suspected cervical spine injury remains a challenge for the anesthesiologist. Most often the airway is secured in trauma patients through direct laryngoscopy. However, the act of direct laryngoscopy results in the movement of the cervical spine,1 which may worsen a preexisting injury. In an attempt to reduce motion of the cervical spine that occurs during airway management, the application of inline stabilization is recommended.1 This procedure has been shown to minimize the degree of cervical spine extension,2 and it is safe in patients with these injuries.3, 4 Alternative techniques further reduce the degree of cervical spine motion, when compared with direct laryngoscopy, and thus provide an additional measure of safety in preventing aggravation of a preexisting injury. The Bullard laryngoscope (BL) has been shown to result in less cervical spine extension when compared to direct laryngoscopy, but it can take longer than direct laryngoscopy to intubate patients’ tracheas.5 The flexible fiberoptic bronchoscope (FFB) should also be considered in the management of patients who are predisposed to cervical spine injury. However, to date, no study has prospectively evaluated this comparison in anesthetized patients. Thus, we have undertaken a study to compare the BL with the FFB with respect to time to intubate and the quality of the laryngeal view in patients undergoing inline stabilization.
Section snippets
Materials and methods
After Institutional Review Board approval from the Marshfield Clinic, Marshfield, WI, and the Baystate Medical Center, Springfield, MA, 50 adult, ASA physical status I, II, and III patients, who were scheduled for surgical procedure requiring general anesthesia and endotracheal intubation, were enrolled in the study. Exclusion criteria included underlying cervical spine pathology, indications for rapid-sequence induction, or an awake intubation. The 50 participants were divided into two groups
Results
The two groups (those who had cricoid pressure and those who did not) had similar demographic data (Table 1). Because each patient served as his or her own control, comparison within each group was unnecessary.
In the group undergoing intubations without cricoid pressure, both techniques successfully intubated the patient in every case. In one case, the BL’s extension piece was needed to obtain an adequate view. The time for this intubation included the time to decide if the extension piece was
Discussion
This study shows that in anesthetized patients who are undergoing inline stabilization, the BL is faster than the FFB in obtaining a view of the larynx and in intubating patients. Our BL times reflect closely those of other reports. The majority of the patients (70%) with standard BL are intubated within 30 seconds.6 Watts et al.5 compared BL intubation times with and without cricoid pressure and inline stabilization, and they found that BL intubations without inline stabilization took 26 ± 10
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2023, Current Therapy of Trauma and Surgical Critical CareEffectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis
2021, British Journal of AnaesthesiaCitation Excerpt :Inconsistency between indirect and direct comparisons was tested for by comparing the deviance information criteria (DIC) between the inconsistency and the consistency model.25 From a total of 1694 records, 80 eligible studies were identified for inclusion in the qualitative synthesis (PRISMA flow selection diagram, Fig. 1).4–17,26–93 Seventy-one studies involved patients without cervical pathology undergoing an elective procedure (simulated scenarios), eight involved patients undergoing elective cervical spine surgery, and one study involved the emergent intubation of blunt trauma patients.
Intubação de via aérea difícil com broncoscópio flexível
2013, Revista Brasileira de AnestesiologiaA comparison of Trachway intubating stylet and Airway Scope for tracheal intubation by novice operators: A manikin study
2012, Kaohsiung Journal of Medical SciencesCitation Excerpt :The emergence of new technologies has aimed to address this problem by introducing devices that allow for fiber-optic video-assisted visualization of the airway. Various intubating stylets with fiber-optic imaging devices that are currently in clinical use have proven effective for managing difficult airways [4–8]. The Trachway intubating stylet (Biotronic Instrument Enterprise Ltd, Tai Chung, Taiwan) is a recently developed video-assisted system equipped with a rigid intubating stylet, a light source, camera and an adjustable screen attached to the handle [9].
Airway Adjuncts
2008, Emergency Medicine Clinics of North AmericaCitation Excerpt :In simulations of immobile cervical spines, the Bullard laryngoscope seems to be readily learned.48 In a model of cervical in-line stabilization with cricoid pressure, the Bullard laryngoscope was found to be superior to flexible fiberoptic laryngoscopy.49 The Wu scope is a similar design, incorporating a rigid metal laryngoscope with fiberoptic bundles.50