Nishikawa Koji, Yamada Koki, Sakamoto Atsuhiro
Department of Anesthesiology, Nippon Medical School Tama Nagayama Hospital, Nagayama 1-7-1, Tama-shi, Tokyo 206-8512, Japan.
Anesth Analg. 2008 Oct;107(4):1248-52. doi: 10.1213/ane.0b013e318185cecb.
We have designed a new curved laryngoscope blade based on a new concept of reversing the peardrop phenomenon to facilitate a view of the larynx sufficient for intubation in a greater variety of patients than the current Macintosh blade affords. The new design has a bifid tip and S-shaped spatula to exert more effective pressure in the vallecula area, elevate the epiglottis and change directions of the forces on the tongue to prevent posteroinferior displacement of the compressed tongue in the submandibular space during laryngoscopy. A radiograph laryngoscopy technique was used to guide the new blade curvature design and compare the performance of the new blade with the Macintosh blade in patients with or without a difficult airway. Our results confirm that the new blade provides a laryngeal view sufficient to accomplish intubation by compressing the root of the tongue in an anterocephalad direction in the submandibular space and elevating the epiglottis effectively in patients with or without unanticipated difficult airway. The new curved blade can also effectively move the U-shaped epiglottis out of the laryngeal view to facilitate intubation in pediatric patients aged 2 mo-13 yr.
我们基于一种逆转梨状窝现象的新概念设计了一种新型弯曲喉镜叶片,以在比当前麦金托什叶片所能适用的更多类型患者中,提供足以进行插管的喉部视野。新设计具有双叉尖端和S形压舌板,可在会厌谷区域施加更有效的压力,抬起会厌,并改变作用于舌头的力的方向,以防止喉镜检查期间压缩的舌头在下颌下间隙向后下移位。采用X线喉镜技术指导新型叶片的曲率设计,并比较新型叶片与麦金托什叶片在有或无困难气道患者中的性能。我们的结果证实,新型叶片通过在下颌下间隙向前头侧方向压缩舌根并有效抬起会厌,为有或无意外困难气道的患者提供了足以完成插管的喉部视野。新型弯曲叶片还可有效将会厌的U形部分移出喉部视野,以方便2个月至13岁儿科患者的插管。