The C-MAC video laryngoscope versus fiberoptic bronchoscope for awake intubation under ketofol sedation in cervical spine injury patients who are immobilized with a cervical collar: a prospective randomized controlled trial

Purpose: The recently introduced C-MAC video laryngoscope combines the advantages of conventional laryngoscopes and fiberoptic bronchoscopy. Therefore, we compared the C-MAC video laryngoscope with the fiberoptic bronchoscope (FOB) for awake intubation under ketofol sedation in patients with cervical spine injuries. Methods: Sixty patients with traumatic cervical spine injury undergoing elective surgery under general anesthesia were randomly allocated into two groups, FOB and C-MAC, with 30 patients each. After premedication and airway topicalization, an infusion of ketofol was initiated. Intubation was attempted according to group assignment once a sedation score ≥2 was achieved. Total intubation time was recorded along with the percentage of glottic opening score. Patient cooperativeness was assessed by their response to a request to open their mouth and by the degree of cough. The primary objective was intubation success, while secondary assessments included ease of intubation on a Likert scale, complications, and hemodynamic changes. Results: The odds of successful intubation were lower in the C-MAC group than in the FOB group (odds ratio, 0.32; 95% confidence interval, 0.01-8.15; P>0.999). The mean total intubation time was significantly shorter in the C-MAC group than in the FOB group (2.97±2.29 minutes vs. 6.48±2.33 minutes, P<0.001). No significant differences were observed between groups in ease of intubation, patient cooperativeness, or hemodynamic parameters. Conclusions: The C-MAC provided a faster glottic view with comparable ease of intubation and patient cooperation relative to fiberoptic intubation in cervical spine injury under ketofol sedation.