Comparative Analysis of Di?erent Techniques of Airway Management in View of Hemodynamic Stability and Postoperative Complication in Patients Undergoing Atlantoaxial Joint Dislocation Surgery

Different Techniques of Airway Management

Abstract

Background: An ideal technique of intubation of the trachea in patients of atlantoaxial joint dislocation surgery remains unclear. This study was undertaken with the primary objective to compare the three different techniques of airway management, in view of hemodynamic stability in patients undergoing atlantoaxial joint dislocation surgery. The secondary objective was to assess the association of postoperative airway complications and the technique of intubation. Subjects and Methods: Adult patits aged >18years, American Society of Anaesthesiologists grade I-III, undergoing elective atlantoaxial joint dislocation surgery requiring tracheal intubation were included in the study. Patients with anticipated difficult airway, previous history of cervical spine injury or surgery were excluded from the study. Patients were divided into 3groups, Group1: conventional laryngoscopy, Group 2: video laryngoscopy, Group 3: fiberoptic intubation. Hemodynamic and postoperative neurological status was assessed. Results: 90 patients were studied. The mean age of patients of Group 1, Group 2 and Group 3 was 45.23  10.29,46.8 6.8 and 44.73 9.97 years respectively. At baseline MAP, HR and SpO2 were comparable in all three groups with insignificant intergroup difference (P>0.05). After securing the airway, significant increase in MAP(P= 0.016), HR (p=0.001) was seen on comparing the three groups. No significant association was seen between postoperative airway complications and the intubation technique. Among the 90 patients included, 24(26.67%) patients developed postoperative neurological deficit (quadriparesis, n=18 and upper limb paresis, n=6). 15(16.67%) patients required postoperative mechanical ventilation. 8(53.33%) out of 15 were tracheostomized. No correlation was observed between time duration of securing the airway and postoperative neurological deficit (P=0.7224).  Conclusion:  No corration was observed between the technique   or duration of intubation and neurological deterioration in patients undergoing AAD surgery. Conventional laryngoscopy is associated with maximum hemodynamic perturbations and number of reattempts.