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Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes.
Anesthesiology. 1995 Apr; 82(4):859-69.A

Abstract

BACKGROUND

Direct laryngoscopy requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomic reasons or because of cervical spine injury. The Bullard laryngoscope, a rigid fiberoptic laryngoscope, may cause less neck flexion and head extension than conventional laryngoscopes. The purpose of this study was to compare head extension (measured externally), cervical spine extension (measured radiographically), and laryngeal view obtained with the Bullard, Macintosh, and Miller laryngoscopes.

METHODS

Anesthesia was induced in 35 ASA 1-3 elective surgery patients. Patients lay on a rigid board with head in neutral position. Laryngoscopy was performed three times, changing between the Bullard, Macintosh, and Miller laryngoscopes. Head extension was measured with an angle finder attached to goggles worn by the patient. The best laryngeal view with each laryngoscope was assessed by the laryngoscopist. In eight patients, lateral cervical spine radiographs were taken before and during laryngoscopy with the Bullard and Macintosh blades.

RESULTS

Median values for external head extension were 11 degrees, 10 degrees, and 2 degrees with the Macintosh, Miller, and Bullard laryngoscopy (P < 0.01), respectively. Significant reductions in radiographic cervical spine extension were found for the Bullard compared to the Macintosh blade at the atlantooccipital joint, atlantoaxial joint, and C3-C4. Median atlantooccipital extension angles were 6 degrees and 12 degrees for the Bullard and Macintosh laryngoscopes, respectively. The larynx could be exposed in all patients with the Bullard but only in 90% with conventional laryngoscope (P < 0.01).

CONCLUSIONS

The Bullard laryngoscope caused less head extension and cervical spine extension than conventional laryngoscopes and resulted in a better view. It may be useful in care of patients in whom cervical spine movement is limited or undesirable.

Authors+Show Affiliations

Department of Anesthesiology, VA Medical Center, La Jolla, California 92161-5085, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

7717556

Citation

Hastings, R H., et al. "Cervical Spine Movement During Laryngoscopy With the Bullard, Macintosh, and Miller Laryngoscopes." Anesthesiology, vol. 82, no. 4, 1995, pp. 859-69.
Hastings RH, Vigil AC, Hanna R, et al. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology. 1995;82(4):859-69.
Hastings, R. H., Vigil, A. C., Hanna, R., Yang, B. Y., & Sartoris, D. J. (1995). Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology, 82(4), 859-69.
Hastings RH, et al. Cervical Spine Movement During Laryngoscopy With the Bullard, Macintosh, and Miller Laryngoscopes. Anesthesiology. 1995;82(4):859-69. PubMed PMID: 7717556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. AU - Hastings,R H, AU - Vigil,A C, AU - Hanna,R, AU - Yang,B Y, AU - Sartoris,D J, PY - 1995/4/1/pubmed PY - 1995/4/1/medline PY - 1995/4/1/entrez SP - 859 EP - 69 JF - Anesthesiology JO - Anesthesiology VL - 82 IS - 4 N2 - BACKGROUND: Direct laryngoscopy requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomic reasons or because of cervical spine injury. The Bullard laryngoscope, a rigid fiberoptic laryngoscope, may cause less neck flexion and head extension than conventional laryngoscopes. The purpose of this study was to compare head extension (measured externally), cervical spine extension (measured radiographically), and laryngeal view obtained with the Bullard, Macintosh, and Miller laryngoscopes. METHODS: Anesthesia was induced in 35 ASA 1-3 elective surgery patients. Patients lay on a rigid board with head in neutral position. Laryngoscopy was performed three times, changing between the Bullard, Macintosh, and Miller laryngoscopes. Head extension was measured with an angle finder attached to goggles worn by the patient. The best laryngeal view with each laryngoscope was assessed by the laryngoscopist. In eight patients, lateral cervical spine radiographs were taken before and during laryngoscopy with the Bullard and Macintosh blades. RESULTS: Median values for external head extension were 11 degrees, 10 degrees, and 2 degrees with the Macintosh, Miller, and Bullard laryngoscopy (P < 0.01), respectively. Significant reductions in radiographic cervical spine extension were found for the Bullard compared to the Macintosh blade at the atlantooccipital joint, atlantoaxial joint, and C3-C4. Median atlantooccipital extension angles were 6 degrees and 12 degrees for the Bullard and Macintosh laryngoscopes, respectively. The larynx could be exposed in all patients with the Bullard but only in 90% with conventional laryngoscope (P < 0.01). CONCLUSIONS: The Bullard laryngoscope caused less head extension and cervical spine extension than conventional laryngoscopes and resulted in a better view. It may be useful in care of patients in whom cervical spine movement is limited or undesirable. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/7717556/Cervical_spine_movement_during_laryngoscopy_with_the_Bullard_Macintosh_and_Miller_laryngoscopes_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/00000542-199504000-00007 DB - PRIME DP - Unbound Medicine ER -