Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue-P77, Cleveland, OH 44195, USA.
Anesth Analg. 2010 Aug;111(2):427-31. doi: 10.1213/ANE.0b013e3181e3dfd2. Epub 2010 Jun 7.
Direct laryngoscopy of a patient lying on the ground is difficult because the intubator's head is far above the head of the patient, making alignment of the intubator's visual axis with the patient's tracheal axis difficult. The Airway Scope is a laryngoscope designed to facilitate tracheal intubation without requiring alignment of the oral, pharyngeal, and tracheal axes. We thus tested the hypothesis that intubation with the Airway Scope is faster than with the Macintosh laryngoscope in subjects lying on the ground.
Adult surgical patients were enrolled. After anesthesia induction, direct laryngoscopy was performed and airway characteristics noted. Patients were randomly assigned to tracheal intubation by either the Airway Scope (n = 50) or the Macintosh laryngoscope (n = 50). The intubator performed tracheal intubation from a table positioned at the same height as that of the operating table, thus simulating intubating on the ground. An unblinded observer recorded overall intubation success rate, time required for intubation, the number of attempts required for successful intubation, and airway complications related to intubation. Of these, the primary end point was time required for intubation.
Overall intubation success rates were 98% with the Airway Scope and 100% with the Macintosh laryngoscope. Intubation was 17 s faster with the Airway Scope (mean, 18 (SD, 4) seconds) versus the Macintosh laryngoscope (35 (16) seconds). The number of intubation attempts was similar with each device. The incidences of airway complications were similar, with no hypoxia (Spo(2) <95%) occurring in either group.
Both the Airway Scope and the Macintosh laryngoscope offer high success rates in adequately prepared paralyzed patients lying supine at ground level in the hands of a skilled practitioner. However, the Airway Scope facilitated faster tracheal intubation.
由于插管者的头部远高于患者头部，因此让插管者的视线轴与患者的气管轴对齐变得困难，使得躺在地上的患者直接喉镜检查变得困难。气道镜是一种设计用于便于气管插管的喉镜，而无需对齐口腔、咽和气管轴。因此，我们假设在躺在地上的患者中，使用气道镜进行插管比使用 Macintosh 喉镜更快。
纳入成年手术患者。麻醉诱导后，进行直接喉镜检查并记录气道特征。患者随机分为气道镜组（n = 50）或 Macintosh 喉镜组（n = 50）进行气管插管。插管者从与手术台等高的桌子上进行气管插管，从而模拟在地面上进行插管。一名未设盲的观察者记录总的插管成功率、插管所需时间、成功插管所需的尝试次数以及与插管相关的气道并发症。其中，主要终点是插管所需时间。
气道镜组的总体插管成功率为 98%，Macintosh 喉镜组为 100%。气道镜组的插管时间快 17 秒（平均 18（SD，4）秒），而 Macintosh 喉镜组为 35（16）秒。两种设备的插管尝试次数相似。两种设备的气道并发症发生率相似，均未发生缺氧（SpO2<95%）。
在熟练的操作者手中，在准备充分的仰卧位躺在地面上的麻痹患者中，气道镜和 Macintosh 喉镜都能提供很高的成功率。然而，气道镜可更快地进行气管插管。
