Department of Anaesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur J Anaesthesiol. 2011 Nov;28(11):774-80. doi: 10.1097/EJA.0b013e328349a9f9.
We hypothesised that the Blind Intubation Device (BID) would be effective for nasotracheal intubation (NTI) in anaesthetised adults with Mallampati class 3. We also hypothesised that BID may cause less haemodynamic changes due to the avoidance of direct stimulation induced by the Macintosh blade.
The purpose of the study was to compare the effectiveness of the BID with the Macintosh laryngoscope for NTI in anaesthetised adults with Mallampati class 3.
A prospective randomised controlled study.
Operation unit in a University Hospital in Shanghai. Period of the study was from September to November 2010.
Mallampati class 3 adults requiring NTI for elective oral and maxillofacial surgery were randomly assigned to a BID group (n = 25) or a Macintosh laryngoscope group (ML group) (n = 25).
After anaesthesia induction, patients were intubated by a single anaesthesiologist experienced in using both devices.
The mean arterial pressure (MAP) and heart rate (HR) were recorded at specific time points. NTI duration and success rate was compared. Epistaxis-associated and NTI-associated postoperative complications were assessed.
Compared with baseline values, there was a significant increase in MAP in both the BID and ML groups which persisted significantly longer in the ML group. The BID group showed a significantly attenuated MAP value within 30-60 s. The difference between the maximum MAP and the post-induction value was significantly greater in the ML group than in the BID group (64.4 ± 16.1 vs. 45.9 ± 16.1 mmHg, P = 0.0003). Compared with baseline values, there was a significant increase in HR in both groups which persisted longer in the ML group. There was a significantly higher first attempt success rate in the BID group compared with the ML group (100 vs. 76%, respectively, P = 0.022). The NTI duration was 36 s [interquartile range (IQR) 32-40] in the BID group and 33 s (IQR 25.5-41.5) in the ML group. Epistaxis during NTI was less frequent and less severe in the BID group (P = 0.031).
In adults with Mallampati class 3, NTI using the BID caused an attenuated haemodynamic response and showed a higher success rate on the first attempt without increasing adverse events. The BID is an effective alternative to the Macintosh laryngoscope for NTI in anaesthetised adults with Mallampati class 3.
Clinicaltrials.gov identifier: NCT 01170455.
我们假设盲探插管器（BID）在 Mallampati 分级 3 的全麻患者行经鼻气管插管（NTI）时是有效的。我们还假设 BID 可能会引起较少的血流动力学变化，因为它避免了 Macintosh 叶片直接刺激引起的变化。
本研究旨在比较 BID 与 Macintosh 喉镜在 Mallampati 分级 3 的全麻患者行 NTI 中的有效性。
前瞻性随机对照研究。
上海某大学医院的手术单元。研究期间为 2010 年 9 月至 11 月。
需要行择期口腔颌面手术的 Mallampati 分级 3 成人，随机分为 BID 组（n = 25）或 Macintosh 喉镜组（ML 组）（n = 25）。
麻醉诱导后，由一位经验丰富的麻醉师使用两种设备进行插管。
记录特定时间点的平均动脉压（MAP）和心率（HR）。比较 NTI 持续时间和成功率。评估与插管相关的和术后并发症。
与基线值相比，BID 和 ML 组的 MAP 均显著升高，且 ML 组的 MAP 升高持续时间明显更长。BID 组在 30-60 秒内 MAP 值明显降低。ML 组最大 MAP 与诱导后值之间的差值明显大于 BID 组（64.4 ± 16.1 与 45.9 ± 16.1 mmHg，P = 0.0003）。与基线值相比，两组的 HR 均显著升高，且 ML 组的 HR 升高持续时间更长。BID 组首次尝试成功率明显高于 ML 组（100%比 76%，P = 0.022）。BID 组的 NTI 持续时间为 36 秒（IQR 32-40），ML 组为 33 秒（IQR 25.5-41.5）。BID 组插管时鼻出血的频率和严重程度较低（P = 0.031）。
在 Mallampati 分级 3 的成人中，使用 BID 行 NTI 可引起血流动力学反应减弱，首次尝试成功率较高，且不增加不良事件。BID 是 Mallampati 分级 3 的全麻患者行 NTI 的一种有效的 Macintosh 喉镜替代方法。
Clinicaltrials.gov 标识符：NCT 01170455。
