背景:气管插管不仅对医生而且对专职卫生工作者都是一种挽救生命的干预措施。优化患者的头部和颈部位置以获得最佳声门视图是加速气管插管的关键步骤。最近,左头旋转动作被描述为一种创新的气管插管方法,在声门可视化方面有了显着改善,并且可以在进行手术气道之前替代。
目的:本研究比较了直接喉镜检查中嗅探位置与左头旋转的声门视图和插管条件。
方法:这是随机的,开放标签临床试验纳入了2020年9月至2021年1月在碧瑶总医院和医疗中心接受择期外科手术的52名成年患者,这些患者需要在全身麻醉下进行气管插管。实验组(n=26)采用左头旋转45度插管,而对照组(n=26)使用常规嗅探位置进行插管。使用Cormack-Lehane等级和插管难度量表评估声门可视化和插管难度与左头旋转和嗅探位置。分别。成功的插管是通过观察气管导管放置后潮气末CO2监测器中的二氧化碳描记波形来测量的。
结果:左头旋转和嗅探位组的临床人口统计学特征没有显着差异。Cormack-Lehane等级没有统计学上的显着差异,两组中85%的患者被归类为1级和2级。此外,左头旋转或嗅探位插管患者的插管困难量表评分差异无统计学意义;两组均有30.7%的患者容易插管,左头旋转组53.8%和嗅探位组57.6%的插管略有困难。同样,在插管困难量表的七个参数中,两种技术之间没有显着差异,尽管在数字上需要施加额外提升力的患者较少[7(26.9%)与11(42.3%)]或喉压[3(11.5%)与7(26.9%)]当用左头旋转插管时。左头旋转插管成功率为92.3%。100%处于嗅探位置,但这种差异没有统计学意义。
结论:左头旋转可产生与常规嗅探位置相当的喉部暴露和插管缓解。因此,对于不能在嗅探位置插管的患者,左头旋转可能是一种选择,特别是在先进的技术,如视频喉镜和柔性支气管镜是不可用的医院,就像这项研究中的情况一样。然而,因为我们的样本量很小,有必要对更大研究人群进行研究,以确定我们研究结果的普遍性.此外,我们观察到麻醉师对左头旋转技术的熟悉程度不够,并且插管成功率可能会随着从业者获得更多的技术熟悉而提高。
背景:该试验已在国际传统医学临床试验注册中心(ISRCTN23442026)注册。
BACKGROUND: Tracheal intubation is a life-saving intervention, and optimizing the patient\'s head and neck position for the best glottic view is a crucial step that accelerates the procedure. The left head rotation maneuver has been recently described as an innovative alternative to the traditional sniffing position used for
tracheal intubation with marked improvement in glottic visualization.
OBJECTIVE: This study compared the glottic view and intubating conditions in the sniffing position versus left head rotation during direct laryngoscopy.
METHODS: This randomized, open-label clinical trial enrolled 52 adult patients admitted to Baguio General Hospital and Medical Center from September 2020 to January 2021 for an elective surgical procedure requiring
tracheal intubation under general anesthesia. Intubation was done using a 45° left head rotation in the experimental group (n=26), while the control group (n=26) was intubated using the conventional sniffing position. Glottic visualization and intubation difficulty with the two procedures were assessed using the Cormack-Lehane grade and Intubation Difficulty Scale, respectively. Successful intubation is measured by observing a capnographic waveform in the end-tidal CO2 monitor after placement of the endotracheal tube.
RESULTS: There was no statistically significant difference in the Cormack-Lehane grade, with 85% (n=44) of patients classified under grades 1 (n=11 and n=15) and 2 (n=11 and n=7) in the left head rotation and sniffing position groups, respectively. In addition, there were no statistically significant differences in the Intubation Difficulty Scale scores of patients intubated with left head rotation or sniffing position; 30.7% (n=8) of patients in both groups were easily intubated, while 53.8% (n=14) in left head rotation and 57.6% (n=15) in sniffing position groups were intubated with slight difficulty. Similarly, there were no significant differences between the 2 techniques in any of the 7 parameters of the Intubation Difficulty Scale, although numerically fewer patients required the application of additional lifting force (n=7, 26.9% vs n=11, 42.3%) or laryngeal pressure (n=3, 11.5% vs n=7, 26.9%) when intubated with left head rotation. The intubation success rate with left head rotation was 92.3% versus 100% in the sniffing position, but this difference was not statistically significant.
CONCLUSIONS: Left head rotation produces comparable laryngeal exposure and intubation ease to the conventional sniffing position. Therefore, left head rotation may be an alternative for patients who cannot be intubated in the sniffing position, especially in hospitals where advanced techniques such as video laryngoscopes and flexible bronchoscopes are unavailable, as is the case in this study. However, since our sample size was small, studies with a larger study population are warranted to establish the generalizability of our findings. In addition, we observed inadequate familiarity among anesthesiologists with the left head rotation technique, and the intubation success rate may improve as practitioners attain greater technical familiarization.
BACKGROUND: International Standard Randomised Controlled Trial Number (ISRCTN)ISRCTN23442026; https://www.isrctn.com/ISRCTN23442026.