Tracheal intubation and cervical spine excursion: direct laryngoscopy vs. intubating laryngeal mask

Until recently, the most appropriate technique of intubating a patient with a cervical spine injury has been the subject of debate. Tracheal intubation by means of the intubating laryngeal mask (Fastrach), a modified conventional laryngeal mask airway, seems to require less neck manipulation. The aim of this study was to compare the excursion of the upper cervical spine during tracheal intubation using direct laryngoscopy with that during intubation via the laryngeal mask (Fastrach), by examination of lateral cervical spine radiographs in healthy young patients. The intubating laryngeal mask (Fastrach) caused less extension (at C1-2 and C2-3) than intubation by direct laryngoscopy. Direct laryngoscopy is still the fastest method to secure an airway provided no intubating difficulties are present. However, in trauma patients requiring rapid sequence induction and in whom cervical spine movement is limited or undesirable, the intubating laryngeal mask (Fastrach) is a safe and fast method by which to secure the airway.