背景:Macintosh刀片直接喉镜检查广泛用于气管内插管。它可能,然而,提供具有挑战性气道解剖结构的患者声门的不完整视图。因此,已经开发了各种视频喉镜来增强声门的可视化并促进插管。然而,这些视频喉镜用于使用双腔气管导管(DLT)插管的有效性,更长的时间,较大,与单腔气管内导管的自然半圆形曲率相反,具有线性构造,仍然不确定。我们假设,与成年人体模型中的Macintosh刀片相比,视频喉镜对DLT插管的效率更高。
方法:94个麻醉提供者,由67名居民组成,15名研究员,和12位与会者,试图插管正常气道解剖的成年人体模型(Laerdal,Wappingers瀑布,NY,美国)使用37Fr左侧DLT。使用了三种不同的插管设备:C-MAC®视频喉镜(KarlStorzGmbH&Co.KG,Tuttlingen,德国),GlideScope®视频喉镜(VerathonInc.,Bothell,WA),使用了Macintosh刀片直接喉镜。每个参与者用三个设备中的每一个插入一个人体模型一次。参与者通过交叉设计进行随机化,其中设备的顺序通过使用拉丁方设计来确定。比较了三种不同装置的插管时间和插管失败(食管插管)的次数。
结果:C-MAC®插管的平均时间,GlideScope®,Macintosh刀片分别为18.57±0.77、36.26±2.69和20.76±0.96秒,分别。GlideScope®与其他两种喉镜之间存在统计学上的显着差异(P<0.001)。C-MAC®和Macintosh刀片的时间没有显著差异。有两次首次尝试使用Macintosh插管失败。
结论:C-MAC®和Macintosh刀片在气道解剖结构正常的人体模型的DLT插管时间方面均被证明更有效,与GlideScope®相比。考虑到首次插管失败的发生,C-MAC®是三种喉镜中最有效的装置,可及时成功地对成年人体模型进行DLT插管.需要进一步的研究来证实这些结果在人类受试者中。
BACKGROUND: Macintosh blade direct laryngoscopy is widely used for endotracheal intubation. It may, however, provide an incomplete view of the glottis in patients with challenging airway anatomy. Consequently, various video laryngoscopes have been developed to enhance the visualization of the glottis and facilitate intubation. Yet, the effectiveness of these video laryngoscopes for intubation using a double-lumen endotracheal tube (DLT), which is longer, larger, and more rigid and has a linear configuration as opposed to the naturally semicircular curvature of a single-lumen endotracheal tube, remains uncertain. We hypothesized that video laryngoscopes would be more efficient for DLT intubation compared to the Macintosh blade in an adult manikin.
METHODS: Ninety-four anesthesia providers, comprising 67 residents, 15 fellows, and 12 attendings, attempted to intubate an adult manikin with normal airway anatomy (Laerdal, Wappingers Falls, NY, USA) using a 37 Fr left-sided DLT. Three different intubation devices were used: the C-MAC® video laryngoscope (Karl Storz GmbH & Co. KG, Tuttlingen, Germany), the GlideScope® video laryngoscope (Verathon Inc., Bothell, WA), and the Macintosh blade direct laryngoscope-were used. Each participant intubated a manikin once with each of the three devices. Participants were randomized via a crossover design with the order of devices determined by using a Latin square design. Time to intubation and the number of failed intubations (esophageal intubation) were compared across the three different devices.
RESULTS: Mean times to intubation for the C-MAC®, GlideScope®, and
Macintosh blades were 18.57 ± 0.77, 36.26 ± 2.69, and 20.76 ± 0.96 seconds, respectively. There was a statistically significant difference (P<0.001) between the GlideScope® and the other two laryngoscopes. The times for C-MAC® and
Macintosh blades were not significantly different. There were two instances of first-attempt failed intubation with the
Macintosh.
CONCLUSIONS: Both the C-MAC® and the
Macintosh blades proved more efficient in terms of time to DLT intubation in the manikin with normal airway anatomy, when compared to the GlideScope®. Considering the occurrence of first-attempt failed intubation, the C-MAC® was the most effective device among the three laryngoscopes for timely successful DLT intubation in the adult manikin. Further studies are needed to confirm these results in human subjects.