16 In experiment 2, we determined whether cadaver intubation biomechanics changed with repeated (four to six) intubations. Therefore, in experiment 1, we measured intubation forces and cervical spine motion in cadavers that underwent intubations with two different laryngoscopes ( e.g., Macintosh and Airtraq ) and compared these values with those obtained in a prior clinical study in which patients underwent intubations with the same two devices. 19, 20 If repeated intubations change cadaver biomechanical properties, then cervical spine motion observed during the nth intubation could differ from what would be observed during the first intubation, potentially confounding the data. These observations differ from in vitro studies (nonliving tissue) in which motion/force relations change with repeated applications of force, particularly during the first few (one to three) load application cycles. In our previous clinical study, 16 as well as in two other clinical studies, 17, 18 intubation biomechanics in patients did not appear to be greatly affected by repeated (two) intubations. 5–15 An important but unanswered question is whether cadavers are a valid biomechanical model of intubation. 4 Instead, virtually all such studies have been performed in cadavers.
1–3 However, only a single clinical study has formally reported cervical spine motion during intubation in the presence of an unstable cervical spine. LARYNGOSCOPY and endotracheal intubation in the presence of cervical spine instability are considered to put patients at risk of cervical spinal cord injury.
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