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Cited by 31Airway Management and Intubation TechniquesRestraint-Related DeathsSpinal Fractures and Fixation Techniques

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Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation in Cadavers—Cadavers versus Patients, the Effect of Repeated Intubations, and the Effect of Type II Odontoid Fracture on C1-C2 Motion

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Hindman, Bradley J., From, Robert P., Fontes, Ricardo B., Traynelis, Vincent C., Todd, Michael M., Zimmerman, M. Bridget, Puttlitz, Christian M., Santoni, Brandon G.·2015·Anesthesiology
DOI 10.1097/aln.0000000000000830PMC PMC4618231
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Abstract

AbstractAbstract: Biomechanics during laryngoscopy revealed similarity of laryngoscope forces and cervical spine motion between humans and cadavers. Repeated intubation procedures changed biomechanics during laryngoscopy in cadavers. In cadavers with a type II odontoid fracture, cervical motion during intubation with either the Macintosh or the Airtraq (Airtraq LLC, USA) did not greatly exceed the range observed in intact cervical spines during the same procedures. Supplemental Digital Content is available in the text. Background: The aims of this study are to characterize (1) the cadaver intubation biomechanics, including the effect of repeated intubations, and (2) the relation between intubation force and the motion of an injured cervical segment. Methods: Fourteen cadavers were serially intubated using force-sensing Macintosh and Airtraq laryngoscopes in random order, with simultaneous cervical spine motion recorded with lateral fluoroscopy. Motion of the C1-C2 segment was measured in the intact and injured state (type II odontoid fracture). Injured C1-C2 motion was proportionately corrected for changes in intubation forces that occurred with repeated intubations. Results: Cadaver intubation biomechanics were comparable with those of patients in all parameters other than C2-C5 extension. In cadavers, intubation force (set 2/set 1 force ratio = 0.61; 95% CI, 0.46 to 0.81; P = 0.002) and Oc-C5 extension (set 2 − set 1 difference = −6.1 degrees; 95% CI, −11.4 to −0.9; P = 0.025) decreased with repeated intubations. In cadavers, C1-C2 extension did not differ (1) between intact and injured states; or (2) in the injured state, between laryngoscopes (with and without force correction). With force correction, in the injured state, C1-C2 subluxation was greater with the Airtraq (mean difference 2.8 mm; 95% CI, 0.7 to 4.9 mm; P = 0.004). Conclusions: With limitations, cadavers may be clinically relevant models of intubation biomechanics and cervical spine motion. In the setting of a type II odontoid fracture, C1-C2 motion during intubation with either the Macintosh or the Airtraq does not appear to greatly exceed physiologic values or to have a high likelihood of hyperextension or direct cord compression.

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Research works printed but not linked: 59

  1. 2006, Airway management in adults after cervical spine trauma., Anesthesiology, 104, 1293, 10.1097/00000542-200606000-00026 · DOI · Paper page
  2. 2006, Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department—A systematic review., Emerg Med J, 23, 3, 10.1136/emj.2004.020552 · DOI
  3. 2012, Emergency tracheal intubation immediately following traumatic injury: An Eastern Association for the Surgery of Trauma practice management guideline., J Trauma Acute Care Surg, 73, S333
  4. 2006, Atlantoaxial subluxation in different intraoperative head positions in patients with rheumatoid arthritis., Anesthesiology, 104, 675, 10.1097/00000542-200604000-00010 · DOI
  5. 1984, Experimental cervical spine injury model: Evaluation of airway management and splinting techniques., Ann Emerg Med, 13, 584, 10.1016/S0196-0644(84)80278-4 · DOI · Paper page
  6. 1988, The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine., Ann Emerg Med, 17, 25, 10.1016/S0196-0644(88)80498-0 · DOI
  7. 1993, A methodology to evaluate motion of the unstable spine during intubation techniques., Spine (Phila Pa 1976), 18, 2020, 10.1097/00007632-199310001-00015 · DOI
  8. 1997, The effect of airway maneuvers on the unstable C1-C2 segment. A cadaver study., Spine (Phila Pa 1976), 22, 1215, 10.1097/00007632-199706010-00008 · DOI
  9. 2000, Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation., Ann Emerg Med, 36, 293, 10.1067/mem.2000.109442 · DOI
  10. 2000, Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization., J Neurosurg, 92, 201
  11. 2001, Cervical spinal motion during intubation: Efficacy of stabilization maneuvers in the setting of complete segmental instability., J Neurosurg, 94, 265
  12. 2009, Motion of a cadaver model of cervical injury during endotracheal intubation with a Bullard laryngoscope or a Macintosh blade with and without in-line stabilization., J Trauma, 67, 61
  13. 2012, Comparison of 4 airway devices on cervical spine alignment in a cadaver model with global ligamentous instability at C5-C6., Spine (Phila Pa 1976), 37, 476, 10.1097/BRS.0b013e31822419fe · DOI
  14. 2013, A comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2., Anesth Analg, 117, 126, 10.1213/ANE.0b013e318279b37a · DOI
  15. 2015, Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq®, Macintosh and McCoy laryngoscopes., Anaesthesia, 70, 452, 10.1111/anae.12956 · DOI
  16. 2014, Intubation biomechanics: Laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes., Anesthesiology, 121, 260, 10.1097/ALN.0000000000000263 · DOI
  17. 1996, Force and torque vary between laryngoscopists and laryngoscope blades., Anesth Analg, 82, 462
  18. 2009, Cervical spine motion: A fluoroscopic comparison of the AirTraq laryngoscope versus the Macintosh laryngoscope., Anesthesiology, 111, 97, 10.1097/ALN.0b013e3181a8649f · DOI
  19. 2009, In situ measurement and modeling of biomechanical response of human cadaveric soft tissues for physics-based surgical simulation., Surg Endosc, 23, 1298, 10.1007/s00464-008-0154-z · DOI
  20. 2011, Thiel-fixation preserves the non-linear load-deformation characteristic of spinal motion segments, but increases their flexibility., J Mech Behav Biomed Mater, 4, 2133, 10.1016/j.jmbbm.2011.07.013 · DOI
  21. 2000, Load-displacement properties of the normal and injured lower cervical spine in vitro., Eur Spine J, 9, 104, 10.1007/s005860050219 · DOI
  22. 1991, Spinal immobilization on a flat backboard: Does it result in neutral position of the cervical spine?, Ann Emerg Med, 20, 878, 10.1016/S0196-0644(05)81430-1 · DOI
  23. 1997, Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine: Can they be measured reliability on radiographs?, Spine (Phila Pa 1976), 8, 859
  24. 1999, Assessment of laryngeal view: Percentage of glottic opening score vs Cormack and Lehane grading., Can J Anaesth, 46, 987, 10.1007/BF03013137 · DOI
  25. 1974, The importance of the sagittal diameters of the cervical spinal canal in relation to spondylosis and myelopathy., J Bone Joint Surg Br, 56, 30
  26. 1998, Roentgenological study of the sagittal diameter of the cervical spinal canal in normal adult Japanese., Neurol Med Chir (Tokyo), 38, 83, 10.2176/nmc.38.83 · DOI
  27. 1998, Spinal canal capacity in simulated displacements of the atlantoaxial segment: A skeletal study., J Bone Joint Surg Br, 80, 1073, 10.1302/0301-620X.80B6.0801073 · DOI
  28. 2012, Computerized tomographic morphometric analysis of the cervical spine., Open Orthop J, 6, 250, 10.2174/1874325001206010250 · DOI
  29. 1993, Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery., J Bone Joint Surg Am, 75, 1282, 10.2106/00004623-199309000-00004 · DOI
  30. 2013, Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine., Spine J, 13, 597, 10.1016/j.spinee.2013.02.006 · DOI
  31. 1990, Measurements of the normal cervical spinal cord on MR imaging., AJNR Am J Neuroradiol, 11, 369
  32. 1998, Cervical spinal cord—Smaller than considered?, Spine (Phila Pa 1976), 23, 1513, 10.1097/00007632-199807150-00001 · DOI
  33. 2009, Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation., Anesthesiology, 110, 24, 10.1097/ALN.0b013e318190b556 · DOI
  34. 2007, Craniocervical motion during direct laryngoscopy and orotracheal intubation with the Macintosh and Miller blades: An in vivo cinefluoroscopic study., Anesthesiology, 107, 884, 10.1097/01.anes.0000291461.62404.46 · DOI · Paper page
  35. 1974, Fractures of the odontoid process of the axis., J Bone Joint Surg Am, 56, 1663, 10.2106/00004623-197456080-00017 · DOI
  36. 2001, The stabilizing effects of different orthoses in the intact and unstable upper cervical spine: A cadaver study., J Trauma, 50, 848, 10.1097/00005373-200105000-00012 · DOI
  37. 2014, False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies., J Clin Epidemiol, 67, 850, 10.1016/j.jclinepi.2014.03.012 · DOI
  38. 2003, Prediction of difficult tracheal intubation., Eur J Anaesthesiol, 20, 31, 10.1097/00003643-200301000-00006 · DOI
  39. 2005, Predicting difficult intubation in apparently normal patients: A meta-analysis of bedside screening test performance., Anesthesiology, 103, 429, 10.1097/00000542-200508000-00027 · DOI
  40. 2009, Aging of the cervical spine in healthy volunteers: A 10-year longitudinal magnetic resonance imaging study., Spine (Phila Pa 1976), 34, 706, 10.1097/BRS.0b013e31819c2003 · DOI
  41. 2008, Quantifying the effects of age, gender, degeneration, and adjacent level degeneration on cervical spine range of motion using multivariate analyses., Spine (Phila Pa 1976), 33, 183, 10.1097/BRS.0b013e31816044e8 · DOI
  42. 2012, Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects., Eur Spine J, 21, 1492, 10.1007/s00586-012-2167-5 · DOI
  43. 2007, The temperature-dependent viscoelasticity of porcine lumbar spine ligaments., Spine (Phila Pa 1976), 32, E436, 10.1097/BRS.0b013e3180b7fa58 · DOI
  44. 2009, Temperature-dependent viscoelastic properties of the human supraspinatus tendon., J Biomech, 42, 546, 10.1016/j.jbiomech.2008.11.013 · DOI
  45. 2001, Mechanical properties of the human cervical spine shown by three-dimensional load-displacement curves., Spine (Phila Pa 1976), 24, 2692
  46. 2012, The effect of soft-tissue restraints after type II odontoid fractures in the elderly: A biomechanical study., Spine (Phila Pa 1976), 37, 1030, 10.1097/BRS.0b013e31823b4ed0 · DOI
  47. 2000, Epidemiology of spinal cord injury after acute odontoid fractures., Neurosurg Focus, 8, e4
  48. 2013, Treatment modality in type II odontoid fractures defines the outcome in elderly patients., BMC Surg, 13, 54, 10.1186/1471-2482-13-54 · DOI
  49. 2010, Surgical treatment of unstable type II odontoid fractures in skeletally mature individuals., Spine (Phila Pa 1976), 35, S209
  50. 2011, Type II odontoid fractures in the elderly: An evidence-based narrative review of management., Eur Spine J, 20, 195, 10.1007/s00586-010-1507-6 · DOI
  51. 2013, Management of isolated fractures of the axis in adults., Neurosurgery, 72, 132
  52. 1992, The onset and progression of spinal injury: A demonstration of neutral zone sensitivity., J Biomech, 25, 1165, 10.1016/0021-9290(92)90072-9 · DOI
  53. 1999, Cervical flexion, extension, protrusion, and retraction. A radiographic segmental analysis., Spine (Phila Pa 1976), 24, 240, 10.1097/00007632-199902010-00008 · DOI
  54. 2007, The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension., Eur Spine J, 16, 1435, 10.1007/s00586-007-0372-4 · DOI
  55. 2013, Six-degrees-of-freedom cervical spine range of motion during dynamic flexion-extension after single-level anterior arthrodesis: Comparison with asymptomatic control subjects., J Bone Joint Surg Am, 95, 497, 10.2106/JBJS.K.01733 · DOI
  56. 2007, Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome—Prospective study with 100 consecutive patients., Radiology, 243, 820, 10.1148/radiol.2433060583 · DOI
  57. 1995, Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression., J Bone Joint Surg Am, 77, 1042, 10.2106/00004623-199507000-00010 · DOI
  58. 2003, Sustained spinal cord compression: Part I: time-dependent effect on long-term pathophysiology., J Bone Joint Surg Am, 85-A, 86
  59. 2013, Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: A battle of time and pressure., PLoS One, 8, e72659, 10.1371/journal.pone.0072659 · DOI

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Metadata

Authors
Hindman, B. J., From, R. P., Fontes, R. B., Traynelis, V. C., Todd, M. M., Zimmerman, M. B., Puttlitz, C. M., & Santoni, B. G.
Affiliations
University of Iowa (US)
Corresponding author
Hindman, Bradley J.
ORCID
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-11
Volume
123
Issue
5
Pages
1042-1058
ISSN
0003-3022 (ISSN-L)
DOI
10.1097/aln.0000000000000830
PMC
PMC4618231
OpenAlex
W2186032632
Cited by
31
References
0
Citations by year
2025: 3 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 4 · 2017: 6 · 2016: 1
FWCI
4.41
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Rush University
  • National Institutes of Health
  • National Institute of Biomedical Imaging and Bioengineering (R01EB012048)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
  • Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
Keywords
laryngoscopy, cervical spine mobility, type II odontoid fracture, Macintosh laryngoscope, Airtraq laryngoscope, cadaveric model, fluoroscopy
MeSH terms
Adult, Aged, Aged, 80 and over, Biomechanical Phenomena, Cadaver, Cervical Vertebrae, Female, Humans, Intubation, Laryngoscopy, Larynx, Male, Middle Aged, Motion, Odontoid Process, Radiography, Spinal Fractures, Laryngoscopes

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