Three-dimensional cervical spine movement during intubation using the Macintosh and Bullard laryngoscopes, the bonfils fibrescope and the intubating laryngeal mask airway.

BACKGROUND AND
OBJECTIVE: Cervical spine movement may be limited for morphological reasons or through injury. The major goal of the present study was to evaluate the three-dimensional cervical spine movement during intubation with a Macintosh or Bullard laryngoscope, a Bonfils fibrescope or an intubating laryngeal mask using an ultrasound-based motion system.
METHODS: Forty-eight patients without any history of cervical spine problems who had to undergo elective surgery in general anaesthesia were intubated using a Macintosh or Bullard laryngoscope, a Bonfils fibrescope or an intubating laryngeal mask airway. During intubation, cervical motion as well as overall time to intubation, number of attempts, and postoperative complaints were noted.
RESULTS: The range of cervical spine motion during intubation, especially concerning extension, using the Macintosh laryngoscope was much greater (22.5 degrees +/- 9.9 degrees) than using Bullard (3.4 degrees +/- 1.4 degrees), Bonfils (5.5 degrees +/- 5.0 degrees) or intubating laryngeal mask (4.9 degrees +/- 2.1 degrees). Time to intubate the trachea using Bonfils (52.1 +/- 22.0 s) and intubating laryngeal mask (49.8 +/- 18.7 s) were much longer than with Macintosh (18.9 + 7.1s) and Bullard laryngoscope (16.1 + 6.2 s) (significance level: 0.05).
CONCLUSIONS: Our findings suggest that the Bullard laryngoscope may be a useful adjunct to intubate patients with cervical spine injuries. In elective situations when time to intubation is not critical Bonfils as well as intubating laryngeal mask airway should also be considered as serious alternatives to direct laryngoscopy.