Timmermann Arnd, Russo Sebastian G, Crozier Thomas A, Eich Christoph, Mundt Birgit, Albrecht Bjoern, Graf Bernhard M
Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Germany.
Anesthesiology. 2007 Oct;107(4):570-6. doi: 10.1097/01.anes.0000281940.92807.23.
Because airway management plays a key role in emergency medical care, methods other than laryngoscopic tracheal intubation (LG-TI) are being sought for inadequately experienced personnel. This study compares success rates for ventilation and intubation via the intubating laryngeal mask (ILMA-V/ILMA-TI) with those via bag-mask ventilation and laryngoscopic intubation (BM-V/LG-TI).
In a prospective, randomized, crossover study, 30 final-year medical students, all with no experience in airway management, were requested to manage anesthetized patients who seemed normal on routine airway examination. Each participant was asked to intubate a total of six patients, three with each technique, in a randomly assigned order. A task not completed after two 60-s attempts was recorded as a failure, and the technique was switched.
The success rate with ILMA-V was significantly higher (97.8% vs. 85.6%; P < 0.05), and ventilation was established more rapidly with ILMA-V (35.6 +/- 8.0 vs. 44.3 +/- 10.8 s; P < 0.01). Intubation was successful more often with ILMA-TI (92.2% vs. 40.0%; P < 0.01). The time needed to achieve tracheal intubation was significantly shorter with ILMA-TI (45.7 +/- 14.8 vs. 89.1 +/- 23.3 s; P < 0.01). After failed LG-TI, ILMA-V was successful in all patients, and ILMA-TI was successful in 28 of 33 patients. Conversely, after failed ILMA-TI, BM-V was possible in all patients, and LG-TI was possible in 1 of 5 patients.
Medical students were more successful with ILMA-V/ILMA-TI than with BM-V/LG-TI. ILMA-TI can be successfully used when LG-TI has failed, but not vice versa. These results suggest that training programs should extend the ILMA to conventional airway management techniques for paramedical and medical personnel with little experience in airway management.
由于气道管理在急诊医疗中起着关键作用，因此正在为经验不足的人员寻找除喉镜气管插管（LG-TI）之外的其他方法。本研究比较了通过插管喉罩进行通气和插管（ILMA-V/ILMA-TI）与通过面罩通气和喉镜插管（BM-V/LG-TI）的成功率。
在一项前瞻性、随机、交叉研究中，30名医学专业最后一年的学生，均无气道管理经验，被要求对在常规气道检查中看似正常的麻醉患者进行管理。要求每位参与者以随机分配的顺序总共为6名患者插管，每种技术各3名。两次60秒尝试后仍未完成的任务记录为失败，并更换技术。
ILMA-V的成功率显著更高（97.8%对85.6%；P<0.05），且使用ILMA-V建立通气更快（35.6±8.0对44.3±10.8秒；P<0.01）。ILMA-TI插管成功的次数更多（92.2%对40.0%；P<0.01）。使用ILMA-TI实现气管插管所需的时间显著更短（45.7±14.8对89.1±23.
