Chambers Neil A, Hullett Bruce
Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
Paediatr Anaesth. 2013 Nov;23(11):1002-5. doi: 10.1111/pan.12208. Epub 2013 Jun 7.
Some techniques used to achieve intubation in children predicted to have a difficult airway do not involve direct laryngoscopy or assessment of the laryngeal grade. Direct laryngoscopy may therefore be performed immediately after intubation to provide a record for future anesthetics. It is unknown whether this postintubation grade accurately reflects the standard laryngeal grade in this group.
The aim of the study was to identify those children who were predicted to be a difficult intubation and to perform direct laryngoscopy before and after intubation. We set out to ascertain if direct laryngoscopy performed after intubation could accurately predict the standard un-intubated laryngeal grade in this group.
All children presenting for general anesthesia who were clinically predicted to be a difficult intubation were considered for this study and prospectively recruited. After induction of anesthesia, one study anesthetist performed direct laryngoscopy before and another study anesthetist then performed direct laryngoscopy after intubation. These laryngeal grades were then compared.
A total of 21 children were successfully recruited and studied, and all patients were successfully intubated. Overall, the postintubation grade did not reliably reflect the standard grade, but did not differ by more than one grade in any patient. In one-third of subjects, the postintubation grade was equal to the standard grade, in one-third it was a grade 'easier' and in one-third a grade 'harder'.
Assessment and documentation of a postintubation laryngeal grade does not appear to provide reliable information for future anesthetics and may even have the potential to be misleading. Any such documentation should always refer to the presence of an endotracheal tube and be interpreted with caution.
一些用于预计气道困难儿童的插管技术并不涉及直接喉镜检查或喉部分级评估。因此，可在插管后立即进行直接喉镜检查，以便为未来的麻醉提供记录。尚不清楚这种插管后的分级是否能准确反映该组患儿的标准喉部分级。
本研究的目的是识别那些预计插管困难的儿童，并在插管前后进行直接喉镜检查。我们着手确定插管后进行的直接喉镜检查能否准确预测该组患儿未插管时的标准喉部分级。
所有因全身麻醉就诊且临床预计插管困难的儿童均纳入本研究并进行前瞻性招募。麻醉诱导后，一名研究麻醉医生在插管前进行直接喉镜检查，另一名研究麻醉医生在插管后进行直接喉镜检查。然后比较这些喉部分级。
共成功招募并研究了21名儿童，所有患者均成功插管。总体而言，插管后的分级并不能可靠地反映标准分级，但在任何患者中差异均不超过一个等级。三分之一的受试者，插管后的分级与标准分级相同，三分之一的受试者插管后的分级“更易”一个等级，三分之一的受试者插管后的分级“更难”一个等级。
插管后喉部分级的评估和记录似乎不能为未来的麻醉提供可靠信息，甚至可能产生误导。任何此类记录都应始终提及气管内导管的存在，并谨慎解读。
