Goneppanavar Umesh, Nair Akshay, Kini Gurudas
Department of Anaesthesiology, Kasturba Medical College, Manipal, India.
Indian J Anaesth. 2011 Mar;55(2):154-9. doi: 10.4103/0019-5049.79896.
Lightwand-guided intubation is a semi-blind technique that takes advantage of the anterior location of the trachea in relation to the oesophagus. Fibreoptic evaluation of lightwand-guided intubation has revealed a possibility of laryngeal interference and epiglottic distortion. Jaw lift, tongue traction or a combination of both have been used to assist in lightwand-guided intubation. This study fibreoptically evaluates lightwand-guided intubation using jaw lift and combined jaw and tongue traction. Eighty four patients with normal airway undergoing general anaesthesia were studied. This randomised, double blinded, cross over study was done in two phases. First phase - after achieving adequate depth of anaesthesia, a fibrescope was advanced nasally, and lightwand-guided intubation was carried out under direct fibreoptic visualisation with the aid of either jaw lift or combined jaw and tongue traction. Second phase - Extubation followed by reintubation using the other manoeuvre. Interference with laryngeal structures during intubation and position of the epiglottis at the end of intubation were noted. Epiglottic distortion (deviated to one side/infolded into trachea) was observed in 6 patients with jaw lift and 17 patients with combined jaw and tongue traction (P=0.003). Laryngeal interference was significantly higher (P=0.012) with combined manoeuvre (30/78) than with jaw lift alone (9/81). Although lightwand-guided intubation can be performed quickly and easily, interference with laryngeal structures and distortion of the epiglottis can occur. Jaw lift manoeuvre causes less laryngeal interference than combined jaw and tongue traction applied by a single operator.
光棒引导插管是一种半盲技术，它利用了气管相对于食管的前方位置。对光棒引导插管的纤维光学评估显示存在喉部干扰和会厌变形的可能性。抬颌、牵引舌头或两者结合已被用于辅助光棒引导插管。本研究通过纤维光学评估使用抬颌以及联合抬颌和牵引舌头的方法进行光棒引导插管。研究了84例气道正常且接受全身麻醉的患者。这项随机、双盲、交叉研究分两个阶段进行。第一阶段——达到足够的麻醉深度后，经鼻插入纤维喉镜，并在纤维光学直接可视化的辅助下，借助抬颌或联合抬颌和牵引舌头的方法进行光棒引导插管。第二阶段——拔管后使用另一种操作方法重新插管。记录插管过程中对喉部结构的干扰以及插管结束时会厌的位置。观察到6例采用抬颌方法和17例采用联合抬颌和牵引舌头方法的患者出现会厌变形（偏向一侧/折叠入气管）（P = 0.003）。联合操作方法（30/78）导致的喉部干扰显著高于单独使用抬颌方法（9/81）（P = 0.012）。尽管光棒引导插管可以快速、轻松地进行，但仍可能出现对喉部结构的干扰和会厌变形。由单一操作者进行时，抬颌操作引起的喉部干扰比联合抬颌和牵引舌头的操作要少。
