The effect of Flexible tip Bougie vs. Stylet on Cervical Spine Motion during video laryngoscopic intubation under Manual Inline Stabilisation: A Randomized controlled trial.

Cervical spine motion , particularly at the Occiput–C1 segment, has a risk of neurological deterioration during tracheal intubation in patients with cervical spine pathology. In order to minimize this risk, Manual In-Line Stabilization or cervical collars are routinely employed. Both the techniques reduce cervical motion at the cost of making the airway management difficult. Video laryngoscopy is increasingly preferred over Fiberoptic Bronchoscopy (FOB) due to comparable cervical spine safety and higher first-pass success rates. However, intubation often requires adjuncts such as stylet or bougie, each with its own mechanical profiles. Studies comparing the efficacy of stylet and bougie on the intubation success rate are present. However, the effect of bougie and stylet on cervical spine motion remains unstudied.  Both glottic exposure and tube advancement contribute to cervical spine motion. This study aims to fill this gap by comparing cervical spine motion during videolaryngoscopy (VDL) -guided intubation using a Flexible tip bougie and a Stylet under Manual In-Line Stabilization (MILS). The findings will aid anaesthesiologists in selecting lower-risk intubation techniques for patients with cervical spine instability and may help inform future airway management guidelines. This randomized  controlled trial is designed to compare the cervical spine movement during videolaryngoscopy guided intubation using either a flexible tip bougie or a stylet in patients undergoing cervical spine surgery or neurointerventional procedures under general anesthesia, with the hypothesis that flexible tip bougie guided intubation results in lesser cervical spine motion.