Department of Anesthesiology, Kosei Hospital, Tokyo, Japan.
Anesth Analg. 2011 Apr;112(4):868-74. doi: 10.1213/ANE.0b013e31820c7cdf. Epub 2011 Mar 8.
Tracheal intubation in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. The Airway Scope facilitates intubation even when laryngeal views are poor with direct laryngoscopy, as they often are in the lateral position. We thus compared the efficacy of the Airway Scope in supine patients with those in the left- and right-lateral positions.
Anesthetized adults were randomly assigned to supine, left-lateral, or right-lateral position (n = 43 for each group). Laryngeal views were obtained in the designated position with a Macintosh laryngoscope, and patients' tracheas were subsequently intubated with the Airway Scope. Specifically, we tested the hypothesis that the time required for intubation in the left- and right-lateral positions is not increased by >10 seconds compared with tracheal intubation in the supine position.
Overall intubation success was 100% in the 2 lateral positions, and 98% in the supine position. Intubation times were similar in the left-lateral (24 [5] seconds, mean [SD]), right-lateral (24 [6] seconds), and supine (22 [7] seconds) positions. The numbers of required intubation attempts were similar in the 2 lateral positions and in the supine and left-lateral positions. However, more intubation attempts were required in the supine position than in the right-lateral position (P = 0.004). The incidences of airway complications were similar in each position; no hypoxia, dental injury, or esophageal intubation was observed. Modified Cormack-Lehane and the percentage of glottic opening scores obtained with the Macintosh laryngoscope did not differ between the 2 lateral positions, but the modified Cormack-Lehane and percentage of glottic opening scores were superior in the supine position (all P < 0.001) compared with either of the lateral positions.
Despite worse laryngoscopic views in either lateral position than when patients were supine, intubation with the Airway Scope offered high success rates. Furthermore, intubation time using the Airway Scope in either lateral position was not longer by >10 seconds than in the supine position. The Airway Scope thus seems to be a useful tool when tracheal intubation is required in a laterally positioned patient.
由于直接喉镜检查时会影响喉部视野，因此侧卧位气管插管较为困难。气道镜即使在直接喉镜检查时喉部视野不佳的情况下，也能方便地进行插管，因为这种情况在侧卧位时经常发生。因此，我们比较了气道镜在仰卧位患者与左侧和右侧卧位患者中的效果。
麻醉后的成年人被随机分配到仰卧位、左侧卧位或右侧卧位（每组 43 例）。在指定位置使用 Macintosh 喉镜获取喉部视野，然后使用气道镜对患者的气管进行插管。具体来说，我们检验了以下假设，即在左侧和右侧卧位时，插管所需时间不会比仰卧位时增加超过 10 秒。
在 2 个侧卧位和仰卧位患者中，整体插管成功率均为 100%。左侧卧位（24[5] 秒）、右侧卧位（24[6] 秒）和仰卧位（22[7] 秒）的插管时间相似。在左侧卧位和仰卧位，以及左侧卧位和右侧卧位，所需的插管尝试次数相似。然而，仰卧位所需的插管尝试次数多于右侧卧位（P = 0.004）。每个位置的气道并发症发生率相似；未观察到缺氧、牙齿损伤或食管插管。Macintosh 喉镜的改良 Cormack-Lehane 分级和声门张开度百分比在 2 个侧卧位之间没有差异，但仰卧位的改良 Cormack-Lehane 分级和声门张开度百分比均优于左侧卧位和右侧卧位（均 P < 0.001）。
尽管在左侧卧位和右侧卧位时的喉镜视野比仰卧位时差，但使用气道镜进行插管仍具有很高的成功率。此外，在左侧卧位或右侧卧位使用气道镜进行插管的时间不会比仰卧位时延长超过 10 秒。因此，当需要在侧卧位患者中进行气管插管时，气道镜似乎是一种有用的工具。
