Radiographic comparison of cervical spine motion using LMA Fastrach, LMA CTrach, and the Macintosh laryngoscope

Abstract

Background/aim: The optimal technique for airway management in patients with cervical pathology remains unclear. Intubatinglaryngeal mask airway devices such as LMA CTrach and LMA Fastrach have not been compared for cervical spine (C-spine) movementsin the context of cervical pathology. The present study aimed to determine upper C-spine movements by radiography during intubationwith different devices as well as comparing the duration and success of intubation in cervical surgery.Materials and methods: Sixty patients scheduled for elective cervical surgery were registered in this prospective, randomized study.Patients with cervical trauma/injury, previous neck surgery, and body mass index (BMI) of >35 kg/m2 were excluded. Participants wererandomized to one of the 3 groups: LMA CTrach, LMA Fastrach, or the Macintosh laryngoscope. C-spine motion was evaluated bymeasuring angles created by bordering vertebrae at cervical 1/2 and 2/3 (C1/2, C2/3) segments on 2 lateral cervical radiographs for eachpatient. Intubation time, ease of intubation, number of attempts, and success rate were also documented.Results: Demographic data were similar in all the groups. The cervical movement with LMA CTrach and LMA Fastrach compared tothe Macintosh laryngoscope were similar at C1/2. However, LMA CTrach significantly reduced extension compared to LMA Fastrachand Macintosh laryngoscopes at C2/3. Duration of intubation was significantly shorter with the Macintosh laryngoscope. The rate ofsuccessful intubation was 80% with LMA Fastrach and 100% with both LMA CTrach and the Macintosh laryngoscopes.Conclusion: The LMA CTrach laryngoscopy involves less upper C-spine movement than the LMA Fastrach and does not increase theduration of the intubation period.