Approach Combining the Airway Scope and the Bougie for Minimizing Movement of the Cervical Spine during Endotracheal Intubation

Background: The Airway Scope (AWS, AWS-S100; Hoya-Pentax, Tokyo, Japan), a recently introduced video laryngoscope, has been reported to reduce movement of the cervical spine during intubation attempts in comparison with conventional laryngoscopes. Use of the bougie as an aid for the AWS may cause further reduction. The authors compared cervical spine movement during intubation with the AWS with and without a bougie. Methods: Thirty patients without cervical spine abnormality were randomized into two groups: intubation with AWS only and intubation with the AWS and the bougie. The cervical spine motion between the occiput (CO) and the fourth cervical vertebra (C4) was observed fluoroscopically, and change in movement between adjacent vertebrae created by each intubation method was compared. Time to intubation was also measured. Results: Laryngoscopy with the AWS produced extension of the cervical spine segments assessed (C0-4). Median extension angle of the C0-4 during intubation using the AWS was reduced from 16.0 degrees without the bougie to 6.5 degrees with the bougie (P < 0.01). There was no significant difference in time to intubation between them. Conclusions: Use of the bougie resulted in significantly reduced extension of the cervical spine during intubation attempt with the AWS in patients with a normal cervical spine.