The Comparison Among Four Intubation Methods In The Cervical Spinal Cord Injury Patient

Objective: To compare the effects of four endotracheal intubation methods on flexion of the impact , hemodynamic fluctuations, intubation complications,and prognosis of spinal cord injury in patients with cervical spinal cord injury .To seek the safe, feasible and easy intubation method.Methods: Choose to be intubated general anesthesiaSixty ASAⅠorⅡ,NYHAⅠ-Ⅱpatients (both sexes, aged 18-65 years old, 55-100 kg weight, BMI≤30 kg/m2)with cervical spinal cord injury, without obvious indication of a difficult airway (Mouth opening≥3 cm , Thyromental distance≥6.5 cm ) ,without history of using preoperative drugs which effect heart rate and blood pressure were randomly divided into four groups.(n=15 each).Macintosh Laryngoscopy (group A),GlideScope Laryngoscopy (group B),LMA-Fastrach Laryngoscopy (group C),Shikani Laryngoscopy (group D).The following data were recorded and analyzed : Cormark-Lehane grade, totoal intubation attempts,failure for tracheal intubation,and heart rate ,blood pressure at the different time potints of intubation process.Results: There were no difference in ASA class ,ages,sexes,height,weight,mouth opening,Thyromental distance,heart rate and MAP before induction,Mallampati class(P≥0.05).The intubation time of group C was longer than the group A (P<0.01).The Cormark-Lehane grade of group B was better than the group A (P<0.05).The intubation success rate of group B was higher than group A (P<0.01).Compared with group A ,the intubation success rate of group C and group D were lower(P<0.05).When glottic was exposed,the cervical flexion changes in group C and group D were less than group A and group B (P<0.05).After intubation, the cervical fexion changes of group D was less than group A(P<0.05).After intubation, the cervical fexion changes of group C and group D was less than group B(P<0.05). During intubation and at 1 min,2min after intubation,the heart rate changes of group D were less than group A (P<0.05).During intubation the MAP changes of group C was less than group A (P<0.05).At 2 min after intubation the MAP changes of group C was less than group B(P<0.05),There were no significant difference in complications after intubation.Postoperative JOA score was higher than the preoperative JOA score(P<0.05).Conclusins: Four intubation methods have advantages and disadvantages. In terms of safety,intubation Shikani Laryngoscopy and LMA-Fastrach Laryngoscopy might be better than Macintosh Laryngoscopy and GlideScope Laryngoscopy. When glottic was exposed and after intubation they might influence the cervical flexion less. In terms of stability and quickness Shikani Laryngoscopy might be simple ,rapid and less damage than LMA-Fastrach Laryngoscopy. The Shikani Laryngoscopy might be a better alternative for tracheal intubation method in patients with cervical spine injured.