Galinski M, Adnet F, Tran D, Karyo Z, Quintard H, Delettre D, Lebail E, Guignard B, Lebrault C, Chauvin M
Département d'Anesthésie-Réanimation, Avicenne Hospital, Samu 93 - UPRES UA 34-09, Bobigny, France.
Eur J Anaesthesiol. 2003 Sep;20(9):731-5. doi: 10.1017/s0265021503001182.
Intubation of the trachea has been a risky cross-contamination procedure over the past decade because no perfect decontamination procedures exist. Infectious agents found on laryngoscopic devices have the potential for devastating spread of the human immunodeficiency virus, hepatitis viruses B and C and transmissible non-conventional agents. The purpose of this prospective observational study was to assess the quality of endotracheal intubation with disposable laryngoscope blades, under normal intubating conditions.
Anaesthetists were asked to complete daily questionnaires regarding the difficulty of intubation experienced using the Vital View disposable laryngoscope blade (Vital Signs Inc, Totowa, NC, USA). The choice of the type of blade (conventional or disposable blade) for the first attempt at intubation depended only on the operating room assignment. Glottic visualization during laryngoscopy was assessed by the modified Cormack and Lehane classification. Difficult tracheal intubation was evaluated by the intubation difficulty scale (> 5, procedure involving moderate to major difficulty).
The anaesthetic staff recorded 219 intubations. One hundred-and-nineteen of first attempts at laryngoscopy were with disposable blades (DB group) and another 100 with conventional blades (CB group). There were no significant differences between the two groups for Cormack and Lehane score 3, for intubation difficulty scale scores > 5 and for intubation difficulty scale score 0. There were 12 blade changes before successful intubation.
In routine use, the Vital View disposable laryngoscope blade appears to be an efficient device because it does not modify the ease of endotracheal intubation in most cases. Nonetheless, it may be advisable to maintain conventional laryngoscopes in reserve for difficult intubations.
在过去十年中，气管插管一直是一种存在风险的交叉污染操作，因为不存在完美的去污程序。在喉镜设备上发现的感染因子有可能导致人类免疫缺陷病毒、乙型和丙型肝炎病毒以及可传播的非常规病原体的灾难性传播。这项前瞻性观察研究的目的是评估在正常插管条件下使用一次性喉镜叶片进行气管插管的质量。
要求麻醉师每天填写关于使用Vital View一次性喉镜叶片（美国新泽西州托托瓦市Vital Signs公司）进行插管困难程度的问卷。首次插管时叶片类型（传统叶片或一次性叶片）的选择仅取决于手术室分配情况。喉镜检查期间的声门可视化通过改良的科马克和莱汉内分级进行评估。气管插管困难程度通过插管困难量表进行评估（>5，该操作涉及中度至重度困难）。
麻醉人员记录了219次插管。首次喉镜检查中有119次使用一次性叶片（一次性叶片组），另外100次使用传统叶片（传统叶片组）。两组在科马克和莱汉内分级为3级、插管困难量表评分>5以及插管困难量表评分为0方面没有显著差异。成功插管前有12次更换叶片。
在常规使用中，Vital View一次性喉镜叶片似乎是一种有效的设备，因为在大多数情况下它不会改变气管插管的难易程度。尽管如此，为困难插管保留传统喉镜可能是明智的。
