Aikins Noble L, Ganesh Rajpaul, Springmann Kurt E, Lunn Jeffrey J, Solis-Keus Joanne
Texas Tech University Health Science Center (TTUHSC) El Paso, TX, USA.
J Emerg Trauma Shock. 2010 Jan;3(1):9-12. doi: 10.4103/0974-2700.58668.
Selection of the ideal airway device in patients with difficult airways (DA) or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP) who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5) patients who may be more difficult to intubate than normal weight patients.
In this prospective randomized experimental study the author investigates a novice physician's use of the Bullard, Fiberoptic, Fastrach and Trachlight comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device.
The Fastrach was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic. A success rate of 20% (one of five) was achieved with the Trachlight on first attempt after 95 seconds. The Bullard was successful in 40 % (two of five) of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively.
In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach demonstrated the highest success rate.
在困难气道（DA）或潜在困难气道患者中选择理想的气道装置仍存在争议，尤其是对于新手麻醉医师（NP）而言，在插管失败后必须偏离使用硬质喉镜的传统直接喉镜检查方法，并使用几种替代装置之一。作者确定并比较了新手医师使用四种替代气道装置对20名肥胖（体重指数超过27.5）患者进行气管插管的成功率、成功所需时间及并发症，这些肥胖患者可能比正常体重患者更难插管。
在这项前瞻性随机实验研究中，作者调查了新手医师使用Bullard喉镜、纤维喉镜、Fastrach喉镜和Trachlight喉镜进行经口气管插管的可靠性、速度和安全性。麻醉诱导后，NP对每种装置进行经口插管时最多允许尝试两次。评估每种装置的平均插管时间（±标准差）、成功率和术后并发症。
Fastrach喉镜首次尝试成功率为100%，平均时间为55秒（±6.6秒）。使用纤维喉镜两次尝试均未成功。Trachlight喉镜在95秒后首次尝试成功率为20%（5例中的1例）。Bullard喉镜在平均时间60秒（±5秒）后，40%（5例中的2例）患者插管成功，但它是唯一导致术后一天出现轻度口腔不适的装置。
在新手医师处理肥胖患者中经常遇到的困难或潜在困难气道时，Fastrach喉镜显示出最高的成功率。
