Obón Monforte H, Romagosa Valls A, Trujillano Cabello J, González Enguita R, Guerrero de la Rotta L F, Sistac Ballarín J M
Servicio de Anestesiologá, Reanimación y Terapéutica del Dolor, Hospital Universitario Arnau de Vilanova, IRBLLEIDA.
Rev Esp Anestesiol Reanim. 2007 Dec;54(10):584-90.
To determine the most common tracheal points of resistance during orotracheal insertion of a fiberoptic tube in a mannequin by applying a maneuver algorithm to overcome the resistance.
Four study groups were established to compare 2 types of endotracheal tube: a standard tube and a reinforced flexible tube with an internal diameter of 7.5 mm. The tubes were used on their own or in combination with a Williams airway intubator. Two fiberoptic bronchoscopes were used, one to perform the test intubation and the other to observe the location of resistance and the effectiveness of the maneuvers for overcoming it. The degree of resistance was scored using a modified Jones scale, from 0 (intubation without resistance) to 4 (intubation impossible); location of resistance and time required for each intubation were also recorded.
A total of 250 oral intubations were performed. Resistance was encountered in 75.2% of the cases. The main locations of obstruction were the right arytenoid cartilage and the posterior commissure. In 89.6% of the cases, intubation of the trachea was achieved without maneuvering or with a 90 degrees counterclockwise rotation. Statistically significant differences were found in resistance and intubation time when the reinforced flexible tube was used with the Williams intubator.
Rotating the tube 90 degrees counterclockwise was an effective maneuver for overcoming resistance. The combination of a reinforced flexible tube and a Williams intubator was associated with less resistance and shorter intubation times.
通过应用一种克服阻力的操作算法，确定在人体模型上经口气管插入纤维光导气管时最常见的气管阻力点。
设立四个研究组以比较两种类型的气管导管：一种标准导管和一种内径为7.5毫米的加强型柔性导管。这些导管单独使用或与威廉姆斯气道插管器联合使用。使用了两台纤维支气管镜，一台用于进行试验性插管，另一台用于观察阻力位置以及克服阻力操作的有效性。使用改良的琼斯量表对阻力程度进行评分，从0（无阻力插管）到4（无法插管）；还记录了阻力位置和每次插管所需时间。
共进行了250次经口插管。75.2%的病例遇到阻力。梗阻的主要位置是右杓状软骨和后联合。89.6%的病例在不进行操作或逆时针旋转90度的情况下成功插入气管。当加强型柔性导管与威廉姆斯插管器联合使用时，在阻力和插管时间方面发现有统计学显著差异。
将导管逆时针旋转90度是克服阻力的有效操作。加强型柔性导管与威廉姆斯插管器联合使用时阻力较小且插管时间较短。
