Suzuki A, Tampo A, Abe N, Otomo S, Minami S, Henderson J J, Iwasaki H
Asahikawa Medical College, Department of Anesthesiology and Critical Care Medicine, Asahikawa, Japan.
Eur J Anaesthesiol. 2008 Jan;25(1):43-7. doi: 10.1017/S0265021507001184. Epub 2007 Aug 1.
The Bullard laryngoscope can be useful in management of difficult airway. When the endotracheal tube is advanced over the original Bullard laryngoscope stylet, the endotracheal tube sometimes makes contact with structures around the vocal cords, especially the right arytenoids. A similar problem also occurs with flexible fibreoptic intubation and it has been shown that use of the Parker Flex-Tip tube usually resolves the problem. In this study we tested our hypothesis that use of the Parker Flex-Tip tube might improve endotracheal tube passage with the Bullard laryngoscope.
Forty patients scheduled for elective anaesthesia were randomly assigned into group ST (standard tube) or Group PT (Parker Flex-Tip tube). The time taken to achieve successful endotracheal tube placement after obtaining the best laryngeal view, the number of attempts at intubation and the incidences of successful intubation at first attempt and of re-direction of the Bullard laryngoscope during intubation were recorded. Unpaired t-test and chi2-test were employed and P < 0.05 was considered significant.
Use of the Parker Flex-Tip tube reduced the time required for successful endotracheal tube placement after the best laryngeal view was obtained from 14 +/- 6 to 6 +/- 2 s (P < 0.01). It also reduced the incidence of requirement for re-direction of the Bullard laryngoscope during intubation from 10/19 to 1/19 (P < 0.01). The incidence of successful intubation at the first attempt (18/19 vs. 15/19) was higher in the PT group but the difference was not statistically significant.
During intubation with the Bullard laryngoscope, use of the Parker Flex-Tip tube is associated with more rapid success and a lower incidence of re-direction of the Bullard laryngoscope during endotracheal intubation when compared to a standard endotracheal tube.
Bullard喉镜在困难气道处理中可能有用。当气管内导管沿原始Bullard喉镜管芯推进时，气管内导管有时会与声带周围结构接触，尤其是右侧杓状软骨。在可弯曲纤维光导插管时也会出现类似问题，并且已经表明使用Parker Flex-Tip导管通常可解决该问题。在本研究中，我们检验了我们的假设，即使用Parker Flex-Tip导管可能会改善使用Bullard喉镜时气管内导管的通过情况。
将40例择期麻醉患者随机分为ST组（标准导管组）或PT组（Parker Flex-Tip导管组）。记录获得最佳喉镜视野后成功置入气管内导管所需的时间、插管尝试次数以及首次尝试成功插管的发生率和插管期间Bullard喉镜重新调整方向的发生率。采用非配对t检验和卡方检验，P<0.05被认为具有统计学意义。
使用Parker Flex-Tip导管使获得最佳喉镜视野后成功置入气管内导管所需的时间从14±6秒减少至6±2秒（P<0.01）。它还使插管期间Bullard喉镜重新调整方向的发生率从10/19降至1/19（P<0.01）。PT组首次尝试成功插管的发生率（18/19对15/19）更高，但差异无统计学意义。
与标准气管内导管相比，在使用Bullard喉镜插管期间，使用Parker Flex-Tip导管与更快的成功率以及气管内插管期间Bullard喉镜重新调整方向的发生率较低相关。
