The C-MAC video laryngoscope versus fiberoptic bronchoscope for awake intubation under ketofol sedation in cervical spine injury patients who are immobilized with a cervical collar: a prospective randomized controlled trial.

PURPOSE: The recently introduced C-MAC video laryngoscope combines the advantages of conventional laryngoscopes and fiberoptic bronchoscopy. Therefore, we compared the C-MAC video laryngoscope with the fiberoptic bronchoscope (FOB) for awake intubation under ketofol sedation in patients with cervical spine injuries.

METHODS

Sixty patients with traumatic cervical spine injury undergoing elective surgery under general anesthesia were randomly allocated into two groups, FOB and C-MAC, with 30 patients each. After premedication and airway topicalization, an infusion of ketofol was initiated. Intubation was attempted according to group assignment once a sedation score ≥2 was achieved. Total intubation time was recorded along with the percentage of glottic opening score. Patient cooperativeness was assessed by their response to a request to open their mouth and by the degree of cough. The primary objective was intubation success, while secondary assessments included ease of intubation on a Likert scale, complications, and hemodynamic changes.

RESULTS

The odds of successful intubation were lower in the C-MAC group than in the FOB group (odds ratio, 0.32; 95% confidence interval, 0.01-8.15; P>0.999). The mean total intubation time was significantly shorter in the C-MAC group than in the FOB group (2.97±2.29 minutes vs. 6.48±2.33 minutes, P<0.001). No significant differences were observed between groups in ease of intubation, patient cooperativeness, or hemodynamic parameters.

CONCLUSIONS

The C-MAC provided a faster glottic view with comparable ease of intubation and patient cooperation relative to fiberoptic intubation in cervical spine injury under ketofol sedation.