Laosuwan Prok, Earsakul Athitarn, Numkarunarunrote Numphung, Khamjaisai Jongkonnee, Charuluxananan Somrat
J Med Assoc Thai. 2015 Jan;98 Suppl 1:S63-9.
Intubation in patients with suspected cervical spine injury must be cautiously performed to avoid any further neurologic trauma. Several intubation techniques have been introduced to minimize cervical spine motion such as the use of the videolaryngoscope.
The present study aims to compare the movement of the cervical spine during intubation by using McGrath series 5 videolaryngoscope (MGL) and that of the conventional Macintosh laryngoscope from cinefluoroscopic imaging.
Twenty-two patients undergoing elective orthopedic surgery that did not involve cervical spine procedure and required general anesthesia were recruited into the study. All patients were randomized either to have intubation with MGL (n = 11) or Macintosh laryngoscope (n = 11) in a neutral position with manual in-line stabilization (MILS). The primary outcome was the cervical vertebral angle changes pre- and post-intubation, measured by cinefluoroscopy. The number of intubation attempts, the laryngoscopic view, the time to intubation, and the incidence ofany complications were recorded as well.
Eleven patients were included in each group without any exclusion from the study. The cervical vertebral angle changes pre- and post-intubation with the MGL was less than with the Macintosh laryngoscope at C3/4 (2.00 vs. 4.27 degrees, respectively; p-value = 0.034) and the cumulative changes of all cervical spine levels (9.18 vs. 17.18 degrees, respectively; p-value = 0.017). However, the time to intubation with the MGL was longer (35.07 vs. 23.21 seconds, p-value = 0.004), the laryngoscope view was better. There were no statistically significant differences in the intubation success rate, the number of attempts, and the incidence of complications.
Orotracheal intubation with MGL provided less cervical spine motion and improved visualization of the vocal cords, without causing adverse consequences as compared with Macintosh laryngoscope and MILS.
对于疑似颈椎损伤的患者，插管操作必须谨慎进行，以避免任何进一步的神经损伤。已经引入了几种插管技术来尽量减少颈椎的活动，例如使用视频喉镜。
本研究旨在通过电影荧光成像比较使用麦格拉斯5系列视频喉镜（MGL）插管期间颈椎的活动与传统麦金托什喉镜插管期间颈椎的活动。
招募22例接受择期骨科手术（不涉及颈椎手术）且需要全身麻醉的患者纳入研究。所有患者均随机分为两组，一组在中立位采用手动直线固定（MILS）使用MGL插管（n = 11），另一组使用麦金托什喉镜插管（n = 11）。主要结局是插管前后颈椎角度的变化，通过电影荧光成像测量。还记录了插管尝试次数、喉镜视野、插管时间以及任何并发症的发生率。
每组纳入11例患者，无患者被排除在研究之外。使用MGL插管前后C3/4节段颈椎角度的变化小于使用麦金托什喉镜（分别为2.00度和4.27度；p值 = 0.034），所有颈椎节段的累积变化也小于使用麦金托什喉镜（分别为9.18度和17.18度；p值 = 0.017）。然而，使用MGL的插管时间更长（35.07秒对23.21秒，p值 = 0.004），喉镜视野更好。插管成功率、尝试次数和并发症发生率无统计学显著差异。
与麦金托什喉镜和MILS相比，使用MGL经口气管插管时颈椎活动较少，声带可视化效果更好，且未造成不良后果。
