Kuo Yi-Wei, Yen Mu-Ken, Cheng Kuang-I, Tang Chao-Shuan, Chau Siu-Wah, Hou Ming-Fung, Wang Jhi-Jong, Lin Shu-Fen
Department of Anesthesiology, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2007 Oct;23(10):504-10. doi: 10.1016/S1607-551X(08)70008-1.
The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI) performed using either the right (dominant) or left (nondominant) hand. Two hundred and forty patients aged 21-64 years, with a Mallampati airway classification grade of I-II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 microg/kg) and thiopentone (5 mg/kg), and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg). In the direct-vision laryngoscope group (group D; n = 80), the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT) into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80), the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80), the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 +/- 9.3 s) or the right-hand (group R; 12.4 +/- 9.2 s), less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 +/- 9.9 s) (p < 0.001). All three groups obtained success rates greater than 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC) was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16.3%, group L 5%, group R 7.5%, p = 0.04). We concluded that LWEI performed by either dominant or nondominant hands resulted in similar efficiency, and could be a suitable alternative to traditional laryngoscopy. It is both feasible and logical for an experienced anesthesiologist to use the nondominant hand to perform LWEI.
本研究旨在评估使用右手（优势手）或左手（非优势手）进行光棒引导气管插管（LWEI）的效率。本随机对照研究纳入了240例年龄在21 - 64岁、Mallampati气道分级为I - II级且在全身麻醉下接受气管插管的患者。通过静脉注射芬太尼（2微克/千克）和硫喷妥钠（5毫克/千克）诱导麻醉，并通过静脉注射阿曲库铵（0.5毫克/千克）辅助气管插管。在直接喉镜组（D组；n = 80）中，插管者左手持喉镜，右手将气管导管（ETT）插入声门开口。在右手进行LWEI的组（R组；n = 80）中，插管者左手抬起患者下颌，右手将ETT - LW装置插入声门开口。相反，在左手进行LWEI的组（L组；n = 80）中，插管者右手抬起下颌，左手插入ETT - LW装置。收集包括总插管时间、插管尝试次数、插管期间的血流动力学变化以及插管后的副作用等数据。无论光棒操作是用左手（L组；11.4±9.3秒）还是右手（R组；12.4±9.2秒）进行，LWEI组消耗的时间都比喉镜组（D组；17.9±9.9秒）少（p < 0.001）。所有三组首次插管尝试的成功率均超过95%。三组间平均动脉血压和心率的变化相似。与L组和R组相比，D组插管相关口腔损伤和室性早搏（VPC）的发生率更高（口腔损伤：D组8.5%，L组1.3%，R组0%，p = 0.005；VPC：D组16.3%，L组5%，R组7.5%，p = 0.04）。我们得出结论，优势手或非优势手进行LWEI的效率相似，并且可以作为传统喉镜检查的合适替代方法。对于经验丰富的麻醉医生来说，使用非优势手进行LWEI既可行又合理。
