European Journal of Cardiovascular Medicine

Introduction: Endotracheal intubation is considered the gold standard for airway management and is usually done by direct laryngoscopy, which requires a 35° flexion of the neck and a 15° extension at the atlanto-occipital joint for optimum visualisation of the glottic opening. Immobilisation of the neck to prevent secondary damage to the spinal cord during intubation in patients with cervical spine injuries limits glottic view, thus making laryngoscopy and intubation extremely difficult. Hence, intubating devices that can provide glottic view without neck manipulation are needed in this population. Objectives: This cross-sectional study aimed to compare the laryngeal views and change in hemodynamic parameters during endotracheal intubation using McCoy & McGrath laryngoscopes in cervical spine-immobilised patients. Methods: A total of 62 cervical spine immobilised patients belonging to the age group 18 to 60 years posted for elective surgeries under general anesthesia in Medical College, Thrissur were studied. 31 of them were intubated using a McCoy laryngoscope, while the rest were intubated using a McGrath videolaryngoscope. Manual in-line axial stabilisation of the neck was done by an assistant. We recorded and compared changes in hemodynamic parameters and laryngeal views based on the Cormack-Lehane classification in the first five minutes after intubation between the two groups. Results: The two groups were similar with respect to demographic data and airway examination. A statistically significant improvement in laryngeal view was observed with the McGrath videolaryngoscope compared to the McCoy laryngoscope, with a p value of .002. No significant difference was noted in hemodynamic parameters at all-time points between the two groups. Conclusion: McGrath videolaryngoscope improves the glottic view compared to McCoy laryngoscope in cervical spine immobilised patients, with no significant difference found between the two in hemodynamic response to laryngoscopy and intubation.