Asai Takashi, Liu Eugene H, Matsumoto Sanae, Hirabayashi Yoshihiro, Seo Norimasa, Suzuki Akihiro, Toi Takashi, Yasumoto Kazumasa, Okuda Yasuhisa
Department of Anesthesiology, Kansai Medical University, Takii Hospital, Osaka, Japan.
Anesthesiology. 2009 Apr;110(4):898-904. doi: 10.1097/ALN.0b013e31819c45e5.
Several case reports have shown that the Pentax-AWS (Hoya Corporation, Tokyo, Japan), a new video laryngoscope, is useful in patients with difficult airways.
We assessed the effectiveness of the Pentax-AWS in two groups. Group 1 included 270 patients in whom direct laryngoscopy using a Macintosh laryngoscope had been difficult. Group 2 included 23 patients with predicted difficult intubation and difficult mask ventilation without previous use of the Macintosh laryngoscope.
In group 1, the view of the glottis with the Macintosh laryngoscope was Cormack and Lehane grade 2 in 14 patients, grade 3 in 208 patients, and grade 4 in 48 patients. In 256 patients in whom the grade was 3 or 4 with the Macintosh laryngoscope, the view with the Pentax-AWS was either grade 1 or 2 in 255 patients (99.6%; 95% confidence intervals 97.8-100%). Tracheal intubation was successful with the Pentax-AWS in 268 of 270 patients (99.3%; 95% confidence interval 97.4-100%), and it failed (after two attempts) in two patients. In group 2, tracheal intubation was successful in 22 of 23 patients, and it failed in one patient. The reasons for failed intubation using the Pentax-AWS were failure to position the blade toward the glottic side of the epiglottis, inability to maneuver the endotracheal tube away from the arytenoids and into the trachea, and bleeding and swelling of the oropharynx.
The success rate of tracheal intubation using the Pentax-AWS was high in patients with difficult laryngoscopy with a Macintosh laryngoscope and in patients with predicted difficult intubation.
多项病例报告显示，新型视频喉镜宾得AWS（日本东京豪雅公司）对气道困难患者有用。
我们在两组患者中评估了宾得AWS的有效性。第1组包括270例使用麦金托什喉镜进行直接喉镜检查困难的患者。第2组包括23例预计插管困难且面罩通气困难、此前未使用过麦金托什喉镜的患者。
在第1组中，使用麦金托什喉镜时声门的视野在14例患者中为科马克和莱哈尼2级，在208例患者中为3级，在48例患者中为4级。在256例使用麦金托什喉镜时视野为3级或4级的患者中，使用宾得AWS时视野在255例患者中为1级或2级（99.6%；95%置信区间97.8 - 100%）。270例患者中有268例使用宾得AWS成功进行了气管插管（99.3%；95%置信区间97.4 - 100%），2例患者插管失败（两次尝试后）。在第2组中，23例患者中有22例气管插管成功，1例患者失败。使用宾得AWS插管失败的原因是叶片未能朝向会厌的声门侧、无法将气管导管从杓状软骨处移开并插入气管以及口咽出血和肿胀。
对于使用麦金托什喉镜进行喉镜检查困难的患者以及预计插管困难的患者，使用宾得AWS进行气管插管的成功率很高。
