Awake intubation using lightwand-guided ILMA versus LMA CTrachTM in patients with simulated cervical spine injury

Abstract

Background and Aims: To study and compare the time taken, success and ease of awake tracheal intubation using lightwand-guided ILMA and LMA CTrach^TM after application of manual in-line stabilization, in adult patients with simulated cervical spine injury.

Methodology: Eighty adult patients were randomized into two groups. In ILMA–LW group trachea was intubated using lightwand-guided ILMA and in LMA CTrach^TM group using CTrach^TM LMA. After anesthetizing patient’s airway with topical local anesthetic, manual in-line stabilization was applied by an assistant, study device was inserted and trachea was intubated through it. The time taken, success and ease of tracheal intubation was noted. The observations of the study were compiled and analyzed statistically. Fischer´s exact test and Chi-square test were used for qualitative data. Quantitative data within groups was analyzed using paired t-test and non-parametric Wilcoxon signed rank test and for quantitative data between groups, Student´s t-test and Wilcoxon Mann Whitney test was used. The level of statistical significance was taken as p < 0.05.

Results: The mean time required for tracheal intubation was 47.86 ± 11.76 sec in ILMA–LW group as compared to 64.84 ± 15.97 sec in LMA CTrachTM group (p < 0.001). Success of tracheal intubation was 87.5% and 80% in group ILMA-LW and group LMA CTrach^TM respectively (p = 0.363). Ease of intubation, number of adjusting maneuvers and intubation attempts, hemodynamic parameters, post-operative oropharyngolaryngeal morbidity and patient’s experience of the procedure were comparable between the two groups.

Conclusion: In patients with simulated cervical spine injury after application of manual in-line stabilization, awake tracheal intubation through lightwand-guided ILMA (ILMA-LW) was significantly faster than LMA CTrach^TM with comparable success and ease of intubation.