Kihara Shinichi, Komatsuzaki Tetsuya, Brimacombe Joseph R, Yaguchi Yuichi, Taguchi Noriko, Watanabe Seiji
*Department of Anesthesia, Mito Saiseikai General Hospital, Ibaraki, Japan; and †University of Queensland and James Cook University, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia.
Anesth Analg. 2003 Nov;97(5):1488-1491. doi: 10.1213/01.ANE.0000082244.93210.2F.
We tested the hypothesis that a silicone-based wire-reinforced tracheal tube with a hemispherical bevel is superior to a polyvinyl chloride (PVC)-based precurved tube with a conventional diagonal bevel for nasotracheal intubation. Eighty anesthetized paralyzed adults (ASA physical status I-II) requiring nasotracheal intubation for tonsillectomy were randomly allocated into two equal-sized groups for airway management with the silicone tracheal tube or PVC tracheal tube. Intubation was subdivided into three phases: 1). passage through the nose into the pharynx, 2). laryngoscope-guided passage into the glottic inlet, and 3). laryngoscope-guided passage into the trachea. A specific sequence of airway maneuvers was followed at each stage if it was unsuccessful. The number of attempts and intubation time were documented by an unblinded observer. The frequency of epistaxis and postoperative nasal complications was documented by blinded observers. There were no intubation failures. The number of attempts at pharyngeal (47 versus 56; P = 0.04) and tracheal (43 versus 55; P = 0.005) placement was smaller for the silicone tracheal tube, but the number of attempts at glottic placement was more (72 versus 49; P < 0.0001). Intubation time was similar. The frequency (32% versus 80%; P < 0.0001) and severity of epistaxis were less for the silicone tracheal tube. The total number of postoperative nasal symptoms was smaller for the silicone tracheal tube (10 versus 21; P < 0.05). We conclude that the pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with the silicone tracheal tube than the PVC tracheal tube but that the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube.
The pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with a silicone-based wire-reinforced tracheal tube with a hemispherical bevel than with a polyvinyl chloride-based precurved tracheal tube with a conventional diagonal bevel, but the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube.
我们检验了这样一个假设，即带有半球形斜面的硅酮材质钢丝强化气管导管在经鼻气管插管方面优于带有传统对角斜面的聚氯乙烯（PVC）材质预弯导管。八十名因扁桃体切除术需要进行经鼻气管插管的麻醉后肌肉松弛的成年人（美国麻醉医师协会身体状况分级I-II级）被随机分为两组，每组人数相等，分别使用硅酮气管导管或PVC气管导管进行气道管理。插管分为三个阶段：1）. 经鼻进入咽部；2）. 在喉镜引导下进入声门入口；3）. 在喉镜引导下进入气管。如果某个阶段操作未成功，则按照特定的气道操作顺序进行。未设盲的观察者记录尝试次数和插管时间。设盲的观察者记录鼻出血和术后鼻腔并发症的发生频率。没有插管失败的情况。硅酮气管导管在咽部（47次对56次；P = 0.04）和气管（43次对55次；P = 0.005）置入时的尝试次数较少，但在声门置入时的尝试次数较多（72次对49次；P < 0.0001）。插管时间相似。硅酮气管导管的鼻出血发生频率（32%对80%；P < 0.0001）和严重程度较低。硅酮气管导管术后鼻腔症状的总数较少（10次对21次；P < 0.05）。我们得出结论，经鼻气管插管的咽部和气管置入阶段使用硅酮气管导管比PVC气管导管所需的尝试次数更少，但声门置入阶段所需尝试次数更多。硅酮气管导管导致的鼻腔发病率较低。
经鼻气管插管的咽部和气管置入阶段，使用带有半球形斜面的硅酮材质钢丝强化气管导管比使用带有传统对角斜面的聚氯乙烯材质预弯气管导管所需的尝试次数更少，但声门置入阶段所需尝试次数更多。硅酮气管导管导致的鼻腔发病率较低。
