Comparison of orotracheal versus nasotracheal fibreoptic intubation in simulated cervical spine patients, under conscious sedation

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts were successful. The ease of fibreoptic intubation was graded to be excellent in a significantly greater number of patients in the nasal group as compared to the oral group. Hemodynamic variability though present was not clinically relevent, this might have been secondary to use of adequate sedation. Conclusion: The ease of fibreoptic intubation in simulated cervical spine injury, under conscious sedation was found to be significantly better in the nasotracheal group. Hemodynamic stability was demonstrated in both the groups in our study.