Comparison of the intubating laryngeal mask airway with the bullard laryngoscope for endotracheal intubation in patients with simulated difficult airway using the philadelphia cervical collar

Background: Intubation of a patient with cervical spine (C-spine) injury, especially in an emergency situation is a challenge even to the most experienced anaesthesiologist. Our goal was to compare the utility and safety of intubating laryngeal mask airway (ILMA) and Bullard laryngoscope (BL) for orotracheal intubation in patients in whom cervical movements are restricted using a Philadelphia cervical collar. Patients and Methods: Thirty two patients requiring orotracheal intubation were enrolled in this prospective, randomised study. Restriction of cervical movements was simulated by removing the pillow under the head and using a Philadelphia collar. They were randomly allocated to one of two groups: Group BL (Bullard laryngoscope) and Group IL (Intubating Laryngeal Mask Airway). After induction and paralysis, intubation was attempted using either ILMA or BL with the collar applied. The total time to intubate, attempts at intubation, haemodynamics, trauma and sore throat were assessed. Results: Application of cervical collar resulted in significant restriction of mouth opening and deterioration of laryngoscopic grade. The success rate for intubation was significantly higher in Group BL [87.5%] as compared to Group IL [50%]. The total time to intubate [Mean (SD)] was significantly longer in the BL [107s (58.88)] compared to ILMA group [60.62s (36.68)]. Conclusion: Philadelphia cervical collar restricts mouth opening significantly and renders laryngoscopy difficult. The BL has a significantly higher success rate than ILMA in intubating patients in whom neck movements are restricted and Philadelphia collar is applied. When successful, intubation time is shorter with ILMA than with BL.