Macnair David, Baraclough Dan, Wilson Graham, Bloch Mark, Engelhardt Thomas
Department of Paediatric Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK.
Paediatr Anaesth. 2009 Jun;19(6):577-80. doi: 10.1111/j.1460-9592.2009.03025.x.
To assess the utility of the Berci-Kaplan Video Laryngoscope (VL) in pediatric anesthesia.
The VL is designed to improve visualization of the glottis during tracheal intubation of normal and difficult airways in adults. This study was designed to assess the visual quality and the ease of tracheal intubation in children using the VL when compared with direct laryngoscopy (DL).
Sixty children, aged 2-16 years requiring tracheal intubation, were enrolled in this prospective, randomized clinical trial. Following induction of anesthesia and muscle paralysis, the first laryngoscopy method, using either a DL or the VL, was performed by one anesthetist, and the laryngoscopic view was graded according to the Cormack-Lehane scale. Laryngoscopy and grading of the view in the second method were then performed by a second anesthetist. Tracheal intubation was completed following the second laryngoscopy, and time to intubation was recorded.
The average age and weight were 8.9 +/- 3.6 years and 34.9 +/- 16.0 kg respectively. Videolaryngoscopy improved 8/11 grade 2 views to grade 1 (P = 0.02), and one grade 3 to a grade 2. Three grade 2 views remained unchanged from DL to VL. 4/30 VL intubations required two attempts, and 1/30 failed after two attempts, but was easily intubated with DL. Median time (range) was 16.0 s (14.0-20.0 s) and 22.5 s (17.8-35.0 s) for DL and VL respectively (P < 0.001).
Videolaryngoscopy provides better views than DL at the expense of time to intubate. Although the time taken to intubate is increased with the VL, it is clinically acceptable.
评估伯西-卡普兰视频喉镜（VL）在小儿麻醉中的效用。
VL旨在改善成人正常气道和困难气道气管插管时声门的可视性。本研究旨在评估与直接喉镜检查（DL）相比，使用VL时儿童气管插管的视觉质量和难易程度。
60名年龄在2至16岁需要气管插管的儿童被纳入这项前瞻性随机临床试验。在麻醉诱导和肌肉松弛后，由一名麻醉师采用DL或VL进行首次喉镜检查方法，喉镜视野根据科马克-莱汉内量表进行分级。然后由第二名麻醉师进行第二种方法的喉镜检查和视野分级。在第二次喉镜检查后完成气管插管，并记录插管时间。
平均年龄和体重分别为8.9±3.6岁和34.9±16.0千克。视频喉镜检查将8/11例2级视野改善为1级（P = 0.02），1例3级改善为2级。3例2级视野从DL到VL保持不变。4/30例VL插管需要两次尝试，1/30例在两次尝试后失败，但用DL很容易插管成功。DL和VL的中位时间（范围）分别为16.0秒（14.0 - 20.0秒）和22.5秒（17.8 - 35.0秒）（P < 0.001）。
视频喉镜检查比DL提供更好的视野，但插管时间会延长。虽然使用VL插管时间增加，但在临床上是可以接受的。
