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A comparison of the effects of conventional and balloon laryngoscopy on the sagittal dimensions of the space available for the cord at the level of the occipitoatlantoaxial complex

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Background

The purpose of this study was to compare the sagittal surface areas (SSAs) of the space available for the cord (SAC) at the occiput (OCC)-first cervical vertebra (C1) and C1-C2 levels determined at neutral head position, and during conventional and balloon laryngoscopy [1,2].

Methods

Anesthesia was induced in eight ASA I, Mallampati I, elective surgery patients. Cross-table lateral-view radiographs were taken at neutral head position (NHP) and upon maximal laryngeal exposure (MLE) with a #4 standard and a #4 modified blade carrying two 10 Foley catheters. MLE during balloon laryngoscopy was achieved by right catheter-balloon inflation with 2 ml air and blade-elevation [1,2]. The radiographs were scanned in Photoshop 5.0, the X-ray magnification was determined, and the OCC-C1 and C1-C2 SAC-SSAs were measured with Autocad 2000. The OCC-C1-SAC and C1-C2-SAC anatomic landmarks are shown in Fig.1. Data were analyzed with Kolmogorov-Smirnov test and ANOVA.

Results

At the OCC-C1 level, the SAC-SSA was significantly reduced during conventional laryngoscopy (MLE-value =0.386± 0.104 in2, NHP-value =0.501± 0.11 in2, P=0.0095). During balloon laryngoscopy, there was no significant SAC-SSA reduction (MLE-value =0.423± 0.128 in2, P=0.07 vs NHP-value), while the SAC-SSA was significantly greater than the SAC-SSA determined during conventional laryngoscopy (P=0.044). At the C1-C2 level, the SAC-SSA-changes were nonsignificant.

Conclusions

The OCC-C1-SAC is significantly less affected by balloon laryngoscopy.

Figure 1
figure1

ABC= inferior margin of occiput. DE=C1-spinous process base. E=most caudal point of C1-spinous process base. F=radiographic intersection of C1 by odontoid-posterior cortex. G=most cephalad point of odontoid-posterior cortex. HI=C2-spinous process base. I=most caudal point of C1-spinous process base. FJ=posterior cortex of C2-vertebral body

References

  1. 1.

    Mentzelopoulos SD, et al.: . Anesth Analg 1999, 88: 1425-1426. 10.1097/00000539-199906000-00051

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  2. 2.

    Mentzelopoulos SD, et al.: . Critical Care 1999, 3(suppl 1): 3-4.

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Mentzelopoulos, S., Tzoufi, M. & Papageorgiou, E. A comparison of the effects of conventional and balloon laryngoscopy on the sagittal dimensions of the space available for the cord at the level of the occipitoatlantoaxial complex. Crit Care 4, P103 (2000). https://doi.org/10.1186/cc823

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Keywords

  • Catheter
  • Full Text
  • Anatomic Landmark
  • Cervical Vertebra
  • Foley Catheter