Cervical Spinal Motion During Orotracheal Intubation

摘要

Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a C4-5 posterior-ligamentous injury in all cadavers. Each intubation was performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. In a completely destabilized C4-5 segment, traction effectively eliminates subluxation, but results in increased distraction. Immobilization effectively eliminates distraction, but results in increased subluxation. Application of no traction or immobilization has intermediate results with more subluxation than traction, and less restriction of lognitudinal motion than immobilization. Nine patients without significant cervical pathology and normal motion of flexion/extension views underwent fluoroscopic monitoring during intubation without and with traction. The traction was applied by hand using Gardner-Wells tongs. One patient could not be intubated safely while traction was administered. Traction during intubation decreases motion of all cervical segments in live patients, with the C2-C3 and C4-C5 levels most affected.