Saracoglu Kemal T, Eti Zeynep, Kavas Ayse D, Umuroglu Tumay
Department of Anesthesiology, Marmara University Medical Faculty, Istanbul, Turkey.
Paediatr Anaesth. 2014 Mar;24(3):297-302. doi: 10.1111/pan.12298. Epub 2013 Nov 12.
It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video-assisted laryngoscope devices for the management of difficult pediatric airway.
Forty-five anesthesiology residents and nurse anesthetists participated in the study. Macintosh, Miller, Storz Miller, and McGrath Mac curved laryngoscopes were used for tracheal intubation of 3-6-month Airsim Pierre Robin manikin. We compared the duration of successful intubation, number of attempts, glottic view grades, severity of dental trauma, the use of optimization maneuvers, and the difficulty of use of the devices with straight and curved laryngoscope blades.
Successful intubation duration was significantly lower in Storz Miller device, and the number of intubation attempts was significantly higher in the Macintosh laryngoscope (P < 0.01). According to the Cormack and Lehane classification, Grades 1 and 2 glottic view was 20% for Macintosh and 40% for Miller laryngoscope, while it was 100% for Storz Miller and 80% for McGrath (P < 0.001). Difficulty VAS scores of Storz Miller device were significantly lower than the scores of Macintosh, Miller, and McGrath laryngoscopes (15.7 ± 14.89, 34.7 ± 26.44, 31.5 ± 26.74, 33.4 ± 26.67 mm, respectively; P < 0.01). The severity of dental trauma was significantly lower in Storz Miller compared with Macintosh, Miller, and McGrath laryngoscopes (0.96 ± 1.04, 1.67 ± 1.15, 1.38 ± 1.05, 1.42 ± 1.27, respectively; P < 0.01).
Storz Miller laryngoscope was found to have advantages over the other laryngoscopes in regard to glottic view, duration of successful intubation, number of attempts, dental trauma severity, need for additional maneuvers, and ease of use.
在小儿患者意外困难气道中，哪种喉镜可能是更好的选择仍存在争议。本研究的目的是比较两种直接喉镜和两种视频辅助喉镜设备在小儿困难气道管理中的效果。
45名麻醉住院医师和麻醉护士参与了本研究。使用麦金托什喉镜、米勒喉镜、史托斯米勒喉镜和麦格拉思麦氏弯曲喉镜对3至6个月大的Airsim皮埃尔·罗宾人体模型进行气管插管。我们比较了成功插管的持续时间、尝试次数、声门视野分级、牙齿创伤的严重程度、优化操作的使用情况以及使用直喉镜和弯喉镜叶片时设备的使用难度。
史托斯米勒设备的成功插管持续时间显著更短，而麦金托什喉镜的插管尝试次数显著更多（P < 0.01）。根据科马克和莱汉内分类，麦金托什喉镜的1级和2级声门视野为20%，米勒喉镜为40%，而史托斯米勒喉镜为100%，麦格拉思喉镜为80%（P < 0.001）。史托斯米勒设备的难度视觉模拟评分显著低于麦金托什、米勒和麦格拉思喉镜（分别为15.7±14.89、34.7±26.44、31.5±26.74、33.4±26.67mm；P < 0.01）。与麦金托什、米勒和麦格拉思喉镜相比，史托斯米勒喉镜的牙齿创伤严重程度显著更低（分别为0.96±1.04、1.67±1.15、1.38±1.05、1.42±1.27；P < 0.01）。
在声门视野、成功插管持续时间、尝试次数、牙齿创伤严重程度、额外操作需求和使用便利性方面，发现史托斯米勒喉镜优于其他喉镜。
