Jo Woo-Young, Hong Chan-Ho, Shin Kyung Won, Oh Hyongmin, Park Hee-Pyoung
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Can J Anaesth. 2025 May;72(5):748-757. doi: 10.1007/s12630-025-02946-y. Epub 2025 Apr 11.
The head-elevated position during videolaryngoscopic intubation enables better visualization of the glottis than the head-flat position. We hypothesized that the head-elevated position would result in less cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.
We conducted a randomized controlled trial in which we assigned patients undergoing coil embolization for unruptured cerebral aneurysms into the head-elevated (N = 55) or head-flat (N = 54) groups. Manual in-line stabilization was applied to simulate cervical spine immobilization during Macintosh-type videolaryngoscopic intubation. To measure the cervical spine angle, two lateral cervical spine radiographs using the capture method were taken, one before and one during intubation, respectively. The primary outcome was cervical spine motion during intubation (cervical spine angle during intubation - cervical spine angle before intubation) at the occiput-C1 segment. We investigated cervical spine motion at the C1-C2 and C2-C5 segments; intubation performance, such as the success rate at the first attempt, intubation time, and frequency of external laryngeal maneuver; and intubation-associated airway complications (airway bleeding, injury, sore throat, and hoarseness).
There was significantly less cervical spine motion at the occiput-C1 segment in the head-elevated group than the head-flat group (mean [standard deviation], 8.6° [5.6°] vs 11.4° [5.7°]; mean difference [95% confidence interval], -2.9° [-5.0 to -0.7]; P = 0.009). Cervical spine motion at the C1-C2 and C2-C5 segments, intubation performance, and intubation-associated airway complications did not significantly differ between the groups.
The head-elevated position during Macintosh-type videolaryngoscopic intubation with manual in-line stabilization resulted in less upper cervical spine motion than the head-flat position.
CRIS.nih.go.kr ( KCT0008669 ); date of registration (approved), 1 August 2023.
在视频喉镜插管过程中，头高位比头平位能更好地观察声门。我们推测，在手动直线固定下进行视频喉镜插管时，头高位会使颈椎运动减少。
我们进行了一项随机对照试验，将因未破裂脑动脉瘤接受线圈栓塞治疗的患者分为头高位组（N = 55）和头平位组（N = 54）。在使用Macintosh型视频喉镜插管期间，应用手动直线固定来模拟颈椎固定。为测量颈椎角度，分别在插管前和插管过程中使用捕捉法拍摄两张颈椎侧位X线片。主要结局是枕骨 - C1节段插管期间的颈椎运动（插管时颈椎角度 - 插管前颈椎角度）。我们研究了C1 - C2和C2 - C5节段的颈椎运动；插管性能，如首次尝试成功率、插管时间和外部喉部操作频率；以及与插管相关的气道并发症（气道出血、损伤、咽痛和声音嘶哑）。
头高位组枕骨 - C1节段的颈椎运动明显少于头平位组（平均值[标准差]，8.6°[5.6°]对11.4°[5.7°]；平均差异[95%置信区间]， - 2.9°[-5.0至 - 0.7]；P = 0.009）。两组之间C1 - C2和C2 - C5节段的颈椎运动、插管性能以及与插管相关的气道并发症没有显著差异。
在使用Macintosh型视频喉镜插管并进行手动直线固定时，头高位比头平位导致上颈椎运动更少。
CRIS.nih.go.kr（KCT0008669）；注册日期（批准），2023年8月1日。
