Aoi Yoshihiro, Inagawa Gaku, Nakamura Kyota, Sato Hitoshi, Kariya Takayuki, Goto Takahisa
Department of Anesthesiology and Critical Care Medicine, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan.
J Trauma. 2010 Oct;69(4):838-42. doi: 10.1097/TA.0b013e3181c4529e.
Tracheal intubation in patients with suspected neck injuries should achieve two contradicting goals-sufficient laryngeal exposure and the least cervical spine movement. Because the former involves displacements of the cervical vertebrae, intubation under immobilization is widely performed today to prevent exacerbation of spinal code injuries. The unique curving blade of the Airway Scope (AWS) is designed to fit the oropharyngeal anatomy. A camera at the tip of the blade displays the view of the larynx, but unlike the direct laryngoscope, it needs no line-of-sight of the oral, pharyngeal, and tracheal axis. Our purpose is to determine whether AWS could be a suitable airway device for the intubation of patients with potential neck injury.
Thirty-six patients scheduled for surgery were randomly assigned to undergo intubation using either AWS or Macintosh laryngoscope (MLS). After general anesthetic induction, the patient's head was set in a neutral position, and an appropriately sized semi-rigid neck collar was placed. Measurements include intubation time, number of attempts, success rate, Cormack-Lehane classification, airway optimization maneuver, Intubation Difficulty Scale scores, and complications.
Intubation time proved no statistical significance (mean ± SD, AWS, 62.9 seconds ± 26.0 seconds, MLS, 55.6 seconds ± 26.0 seconds; p = 0.42). AWS scored less in Cormack-Lehane classification (median [range], AWS I [I-I], MLS IIIa [I-IIIb]; p < 0.0001), required fewer additional airway optimization maneuvers (p = 0.0003), and scored less in Intubation Difficulty Scale scores (AWS 0 [0-1], MLS 2 [0-5]; p < 0.0001).
In neck-immobilized patients using semi-rigid cervical collars, AWS improves laryngeal exposure and facilitates tracheal intubation. AWS may be a suitable intubation device for trauma patients.
对于疑似颈部损伤的患者进行气管插管应实现两个相互矛盾的目标——充分暴露喉部以及使颈椎活动最小化。由于前者涉及颈椎的移位，如今广泛采用在固定状态下进行插管以防止脊髓损伤加重。气道镜（AWS）独特的弯曲镜片设计旨在适配口咽解剖结构。镜片尖端的摄像头可显示喉部视野，但与直接喉镜不同，它无需口腔、咽部和气管轴的直视。我们的目的是确定AWS是否可能是适合潜在颈部损伤患者插管的气道装置。
36例计划接受手术的患者被随机分配使用AWS或麦金托什喉镜（MLS）进行插管。全身麻醉诱导后，将患者头部置于中立位，并放置尺寸合适的半刚性颈托。测量指标包括插管时间、尝试次数、成功率、科马克-莱汉内分级、气道优化操作、插管难度量表评分及并发症。
插管时间无统计学意义（均值±标准差，AWS为62.9秒±26.0秒，MLS为55.6秒±26.0秒；p = 0.42）。AWS在科马克-莱汉内分级中得分更低（中位数[范围]，AWS为I[I-I]，MLS为IIIa[I-IIIb]；p < 0.0001），所需的额外气道优化操作更少（p = 0.0003），且在插管难度量表评分中得分更低（AWS为0[0-1]，MLS为2[0-5]；p < 0.0001）。
在使用半刚性颈托固定颈部的患者中，AWS可改善喉部暴露并便于气管插管。AWS可能是适用于创伤患者的插管装置。
