The Air Ambulance Department, Oslo University Hospital-Ullevål, Sykehusveien 1, Nordbyhagen, Norway.
Acta Anaesthesiol Scand. 2009 Nov;53(10):1257-61. doi: 10.1111/j.1399-6576.2009.02094.x. Epub 2009 Aug 13.
Airway management of entrapped patients is challenging and alternatives to endotracheal intubation with a Macintosh laryngoscope must be considered. In this study, the GlideScope Ranger video laryngoscope has been evaluated as an alternative to standard laryngoscopy.
Eight anaesthesiologists from a Helicopter Emergency Medical Service intubated the trachea of a Laerdal SimMan manikin using the studied laryngoscopes in two scenarios: (A) unrestricted access to the manikin in an ambulance and (B) no access from the head end, simulating an entrapped patient. The time used to secure the airway and the scored level of difficulty were the main variables.
In scenario A, all anaesthesiologists managed to secure the airway using both techniques within the 60-s time limit. In scenario B, all secured the airway when using the video laryngoscope, while 50% succeeded with endotracheal intubation using the Macintosh laryngoscope. The difference in the success rate was statistically significant (P=0.025). There were no significant differences in the time spent on endotracheal intubation in the two scenarios or between the devices. All stated that the availability of a video laryngoscope would make drug-facilitated intubation a realistic alternative when access to patients is limited. The lack of visual control when using the Macintosh laryngoscope excludes this technique in real-life settings.
This study suggests that the GlideScope Ranger may be merited in situations requiring endotracheal intubation by an experienced intubator in patient entrapment. Further studies are required to clarify whether performance in patients mimics that in a manikin.
被困患者的气道管理具有挑战性，必须考虑替代 Macintosh 喉镜进行气管插管。在这项研究中，GlideScope Ranger 视频喉镜已被评估为标准喉镜检查的替代方法。
来自直升机紧急医疗服务的 8 名麻醉师在两种情况下使用研究中的喉镜对 Laerdal SimMan 模拟人进行气管插管：（A）在救护车中不受限制地接触模拟人，和（B）从头部无法进入，模拟被困患者。主要变量是用于确保气道的时间和评分的难度级别。
在场景 A 中，所有麻醉师都在 60 秒的时间限制内使用两种技术成功地确保了气道通畅。在场景 B 中，所有麻醉师都使用视频喉镜成功地确保了气道通畅，而使用 Macintosh 喉镜，50%的人成功地进行了气管插管。成功率的差异具有统计学意义（P=0.025）。在两种情况下或两种设备之间，进行气管插管所花费的时间均无显著差异。所有人都表示，当患者的通道有限时，视频喉镜的可用性将使药物辅助插管成为一种现实的选择。当使用 Macintosh 喉镜时缺乏视觉控制，这使得这种技术在实际环境中无法使用。
本研究表明，在需要经验丰富的插管者进行气管插管的情况下，GlideScope Ranger 可能是合理的选择。需要进一步的研究来阐明在模拟患者中，其性能是否与在模拟人上的性能相匹配。
