Blair E J, Mihai R, Cook T M
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
Anaesthesia. 2007 Apr;62(4):385-7. doi: 10.1111/j.1365-2044.2007.04994.x.
Fibreoptic-assisted tracheal intubation with an Aintree Intubating Catheter via a dedicated airway is sometimes recommended when conventional tracheal intubation fails. This study compares the use of the Classic and Proseal laryngeal mask airways (LMA) for this purpose in a manikin. Twenty-five anaesthetists of all grades performed two intubations with each device. The overall success rate was 95%. The procedure took < 90 s in all cases and < 60 s in 88% of patients. The speed of intubation increased from the first to fourth attempt and between the first and second attempt with each device (p < 0.001). Allowing for the learning effects observed with each device, there was no statistically significant difference found when comparing speed of intubation with the two devices (p > 0.05). There was no significant difference between the devices with regard to ease of advancement of the fibrescope or the view of the vocal cords with the Aintree Intubating Catheter. Four failures occurred with the LMA Classic and one with the LMA Proseal. Subjective comments favoured the LMA Proseal (p < 0.05), although the clinical importance of these comments is difficult to determine. This study has shown that, in a manikin, fibreoptic guided intubation via an LMA Proseal is at least as easy and reliable as through an LMA Classic. In view of the potential advantages of the LMA Proseal for airway rescue and management of the difficult airway, this study suggests a clinical evaluation of the use of the combination of an LMA Proseal and an Aintree Intubating Catheter in patients is justified.
当传统气管插管失败时,有时建议通过专用气道使用安特里气管插管导管进行纤维光学辅助气管插管。本研究在人体模型中比较了经典型和喉罩气道双管型(LMA)用于此目的的情况。25名各级麻醉医生使用每种装置进行了两次插管。总体成功率为95%。所有病例插管过程均<90秒,88%的患者<60秒。每次尝试从第一次到第四次以及每种装置的第一次和第二次尝试之间,插管速度均有所提高(p<0.001)。考虑到每种装置观察到的学习效应,比较两种装置的插管速度时未发现统计学上的显著差异(p>0.05)。在纤维支气管镜推进的难易程度或使用安特里气管插管导管观察声带方面,两种装置之间没有显著差异。经典型LMA出现4次失败,喉罩气道双管型出现1次失败。主观评价更倾向于喉罩气道双管型(p<0.05),尽管这些评价的临床重要性难以确定。本研究表明,在人体模型中,通过喉罩气道双管型进行纤维光学引导插管至少与通过经典型LMA一样容易和可靠。鉴于喉罩气道双管型在气道救援和困难气道管理方面的潜在优势,本研究表明对患者使用喉罩气道双管型和安特里气管插管导管联合应用进行临床评估是合理的。