Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization

J Clin Anesth. 2016 Jun;31:46-52. doi: 10.1016/j.jclinane.2015.12.045. Epub 2016 Mar 22.


Study objective: To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts.

Design: Prospective, randomized, single-blinded study.

Setting: Cedars Sinai Medical Center in Los Angeles, CA.

Patients: One hundred forty patients (American Society of Anaesthesiologists physical status I-III), aged 18 to 80years undergoing elective cervical spine surgery.

Intervention: Patients were prospectively randomized to undergo tracheal intubation using either an FFS (n=70) or the C-MAC video laryngoscope (n=70).

Measurements: After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was assessed at the time of tracheal tube placement using the Cormack-Lehane and percentage of glottic opening scoring systems. In addition, the time required for successful insertion of the tracheal tube, number of intubation attempts to secure the airway, the need for adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded.

Main results: The glottic view at the time of intubation did not differ significantly with the 2 devices; however, the C-MAC facilitated more rapid tracheal intubation compared with the FFS (P=.001). The peak heart rate response following insertion of the tracheal tube was also reduced (P=.004) in the C-MAC (vs FFS) group.

Conclusion: The C-MAC may offer an advantage over the FFS with respect to the time required to obtain glottic view and successful placement of the tracheal tube in patients requiring cervical spine immobilization.

Keywords: C-MAC video laryngoscope; Cormack-Lehane score; Flexible fiberoptic scope; Manual inline stabilization; Percentage of glottic opening (POGO) score; Tracheal intubation.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cervical Vertebrae / surgery*
  • Equipment Design
  • Female
  • Fiber Optic Technology / instrumentation*
  • Fiber Optic Technology / methods
  • Hemodynamics / physiology
  • Humans
  • Immobilization
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Laryngoscopes* / adverse effects
  • Laryngoscopy / adverse effects
  • Laryngoscopy / instrumentation
  • Laryngoscopy / methods
  • Male
  • Middle Aged
  • Prospective Studies
  • Single-Blind Method
  • Time Factors
  • Young Adult