López-Hernández MN, Wilson-Manríquez EA, López-Jiménez FA

Language: Spanish
References: 14
Page: 30-34
PDF size: 301.92 Kb.

ABSTRACT

Introduction: Correct airway management of polytraumatized patients is crucial because of the necessity of securing the airway and providing adequate ventilation without worsening a probable spinal cord injury. Objective: Determine the effect of manual inline stabilization (MILS) on Cormack-Lehane classification and if there is any correlation with body mass index (BMI). Material and methods: In a descriptive study at the Centro Hospitalario del Estado Mayor Presidencial in Mexico City, we included 56 patients with ASA physical status I to IV. The anesthesiologist performed direct laryngoscopy while MILS was performed and observed the CL grade. Immediately after, the patient was repositioned into the sniffing position, direct laryngoscopy was performed, and the CL grade was observed again. Results: The CL grades observed were significantly different between MILS vs. Sniffing position. CL grades were mainly high when positioned in MILS (75% classified as grades III and IV) and diminished significantly when changed to the sniffing position. Conclusion: Improvement of CL grade was observed when changing from MILS to sniffing position.

REFERENCES

1. WHO. Injuries and Violence: The Factos. Geneva, Switzerland: World Health Organization; 2014.

2. Crosby E, Lui A. The adult cervical spine: Implications for airway management. Can J Anaesth. 1990;37:77-93.

3. Trauma ACoSCo. Advance Trauma Life Support Manual Chicago: American College of Surgeons; 1984.

4. Smith CE, Pinchak AB, Sidhu TS, Radesic BP, Pinchak AC, Hagen JF. Evaluation of tracheal intubation difficulty in patients with cervical spine immobilization. Anesthesiology. 1999;91:1253-1259.

5. Bair AE, Filbin MR, Kulkarni RG, Walls RM. The failed intubation attempt in the emergency department: analysis of prevalence, rescue techniques and personnel. J Emerg Med. 2002;23:131-140.

6. Cook TM, Macdougall-Davis SR. Complications and failure of airway management. Br J Anesth. 2012;109:68-85.

7. Nolan J, Wilson M, Park C. Orotracheal intubation in patients with potential cervical spine injuries. Anaesthesia. 1993;48:630-633.

8. Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology. 1994;80:825-831.

9. Adesida A, Desalu I, Adeyemo W, Kushimo O. Manual in-line stabilization of the cervical spine increases the rate of difficult oro-tracheal intubation in adults-a randomized controlled trial. The Annals of African Surgery. 2014;11:10-14.

10. Thiboutot F, Nicole PC, Trepanier CA, Turgeon AF, Lessard MR. Effect of manual in-line stabilization of the cervical spine ina dults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anesth. 2009;56:412-418.

11. Romito JW, Riccio CA, Bagley CA, Minhajuddin A, Barden CB, Michael MM, et al. Cervical spine movement in a cadaveric model of severe spinal instability: a study comparing tracheal intubation with 4 different laryngoscopes. J Neurosurg Anesthesiol. 2020;32:57-62.

12. Lopez-Jimenez FA, Morales-Cuevas JM, Alvarado-Ramos JG, Mondragon-Villanueva ME. Intubación traqueal con mascarilla laríngea C-trach en pacientes con vía aérea y pacientes con lesión cervical. Rev Mex Anest. 2007;30:26-31.

13. Swain A, Bhagat H, Gupta V, Salunke P, Panda NB, Sahu S. Intubating laryngeal mask airway-assisted flexible bronchoscopic intubation is associated with reduced cervical spine motion when compared with C-MAC video laryngoscopy-guided intubation: a prospective randomized cross over trial. J Neurosurg Anesthesiol. 2019;32:242-248.

14. Wang T, Sun S, Huang S. The association of body mass index with dificult tracheal intubation management by direct laryngoscopy: a meta-analysis. BMC Anesthesiology. 2018;18:1-13.