Comparison between C-MAC video laryngoscope versus fibreoptic bronchoscope for awake intubation under ketofol-ketamine plus propofol sedation in cervical spine injury: immobilised with cervical collar: Prospective Randomized Controlled trial”

In patients with cervical spine injury, airway management poses a bigger challenge due to risk of neurological damage related to neck movements thus manual in line stabilization or cervical collar is commonly applied to minimise neck movements, such immobilisation can render intubation under direct laryngoscopy more difficult.

Securing the airway without cervical spine movement to avoid any neurological catastrophe is always an anaesthetic challenge. These issues have prompted the development of number of alternatives to Macintosh laryngoscope such as C-MAC, fibre optic, McCoy laryngoscope, intubating laryngeal mask airway, C-Trach and Bullard laryngoscope.

Awake fibre optic bronchoscope intubation is gold standard in cervical spine injury, but its time consuming and requires more psychomotor skills and training. The C-MAC  is a nonchannelled video laryngoscope. The primary feature of D blade is its shape, which is an elliptically tapered blade raising to the distal. It claims to provide an easy option in difficult laryngoscopies. Studies have done proving that it is less time consuming and intubation time can be shorter and no separate skills needed for using C-MAC as technique is same as laryngoscope technique and gives ease of intubation. There are no studies comparing C-MAC with fibre optic intubation in traumatic cervical spine immobilised with cervical collar.

We planned this study to compare C-MAC intubation with gold standard fibre optic intubation in traumatic cervical spine. Awake intubation has added advantage in assessing neurological status post intubation and we can have control on airway. In an awake, unprepared patient with excessive salivation, gag and cough reflex can make intubation more challenging. These can be reduced by addition of antisialogogues, and  topicalization of airway with nebulisation with 10% lignocaine and achieving sedation with ketofol because of its profound analgesia and amnesia while maintaining protective airway reflexes, spontaneous respiration along with stabilizing hemodynamic profile and quick recovery. Hence, this study aims to compare the efficacy of  success of intubation in first attempt with C-MAC video laryngoscope versus fibre optic bronchoscope for awake intubation under ketofol (ketamine plus propofol) sedation in cervical spine injury: immobilised with cervical collar.