Fiadjoe John E, Stricker Paul A, Hackell Rebecca S, Salam Abdul, Gurnaney Harshad, Rehman Mohamed A, Litman Ronald S
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Anesth Analg. 2009 Jun;108(6):1783-6. doi: 10.1213/ane.0b013e3181a1a600.
Several studies have shown video laryngoscopy to be a useful technique in the management of patients in whom glottic exposure by direct laryngoscopy is difficult. We conducted this study as a preliminary investigation comparing the Storz DCI Miller 1 video laryngoscope (VL, Karl Storz GmbH, Tuttlingen, Germany) and direct laryngoscopy with a Miller 1 laryngoscope (DL) in an infant manikin model simulating difficult direct laryngoscopy. We hypothesized that compared with DL, VL would provide a better glottic view but would be associated with a longer time to intubation because of the different skill set required when using video intubation.
A Laerdal infant airway management training manikin (Laerdal Medical, Wappingers Falls, NY) was adapted using cloth tape to limit cervical spine mobility. Thirty-two attending pediatric anesthesiologists attempted tracheal intubation of the infant manikin using VL and DL in randomized order. The best laryngeal view with each laryngoscope and time to intubation were documented.
There was a significant difference in the distributions of laryngoscopy grades between VL and DL (P < 0.001), with the VL giving a better laryngeal view. Forty percent of anesthesiologists reported a Grade 3 or 4 view with DL; all of which were converted to Grades 1 and 2 with VL. The median grade with interquartile range was two (2-3) for DL and one (1-2) for VL (P < 0.001). Seventy-eight percent of participants reported an improvement of at least one grade in laryngeal view with VL compared with DL. There were two failed intubations using DL and none using VL. Time to intubation was similar between the two techniques.
The Storz Miller 1 VL blade improved glottic exposure in a simulated difficult laryngoscopy compared with direct laryngoscopy with a standard Miller 1 blade without increasing the time to intubation.
多项研究表明，视频喉镜检查是一种用于管理直接喉镜检查时声门暴露困难患者的有用技术。我们进行了这项研究，作为一项初步调查，在模拟困难直接喉镜检查的婴儿人体模型中，比较了史托斯DCI米勒1视频喉镜（VL，卡尔·史托斯有限公司，德国图特林根）和使用米勒1喉镜的直接喉镜检查（DL）。我们假设，与DL相比，VL将提供更好的声门视野，但由于使用视频插管时所需的技能不同，插管时间会更长。
使用布带对Laerdal婴儿气道管理训练人体模型（Laerdal Medical，纽约州瓦平格斯福尔斯）进行改装，以限制颈椎活动度。32名儿科麻醉主治医师按随机顺序使用VL和DL对婴儿人体模型进行气管插管。记录每种喉镜的最佳喉镜视野和插管时间。
VL和DL之间喉镜分级分布存在显著差异（P < 0.001），VL的喉镜视野更好。40%的麻醉医师报告使用DL时视野为3级或4级；使用VL时均转换为1级和2级。DL的中位数分级及四分位间距为2（2 - 3），VL为1（1 - 2）（P < 0.001）。78%的参与者报告与DL相比，使用VL时喉镜视野至少提高了一级。使用DL时有2次插管失败，使用VL时无失败情况。两种技术的插管时间相似。
与使用标准米勒1叶片的直接喉镜检查相比，史托斯米勒1 VL叶片在模拟困难喉镜检查中改善了声门暴露，且未增加插管时间。
