Pandey Ravinder Kumar, Subramanium Raj Kumar, Darlong Vanlal, Lekha Chandra, Garg Rakesh, Punj Jyotsna, Rewari Vimi, Bajpai Meenu
Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pediatric Surgery, AIIMS, New Delhi, India.
Paediatr Anaesth. 2015 Dec;25(12):1241-7. doi: 10.1111/pan.12746. Epub 2015 Sep 29.
We assessed the feasibility of blind orotracheal intubation in children using the Air-QILA as a conduit in supine position and the glottic view grading by fiberoptic bronchoscope (FOB) through it both in supine and lateral positions.
After ethical approval and consent, 60 children were enrolled in the study. In the operating room, after attaching standard monitors to all children, anesthesia was induced with sevoflurane (2-8%) in oxygen (100%). Once the children became sedated, an i.v. access was established and injection glycopyrrolate (10 μg · kg(-1)), fentanyl (2 μg · kg(-1)), and atracurium (0.5 mg · kg(-1)) were administered. After 3 min, the Air-QILA was placed in supine position and glottic view was assessed by using FOB, in supine and right lateral decubitus position. In all children, gradings of glottic view in two different positions were noted. After that all children were turned supine, and orotracheal intubation was done blindly through the Air-QILA. The success rate, insertion time of the Air-QILA, and endotracheal intubation were noted.
The Air-QILA placement was successful in 57 children in first attempt and three children required second attempt. However, blind endotracheal intubations through the Air-QILA were successful in 38 children in first attempt and 12 children required second attempt. In the remaining 10 children, where blind endotracheal intubation through the Air-QILA remained unsuccessful, conventional laryngoscopy was performed. In supine and lateral positions, Grade 1 glottic view was seen in 41 and 38 of total 60 patients, respectively. Turning of all children from supine to lateral decubitus position resulted in the deterioration of grading of glottic view in eight children and improvement in two children (P = 0.001).
The Air-QILA is an easy to place supraglottic airway device with excellent airway seal and low airway morbidity. It may be useful as a conduit for blind orotracheal intubation in supine position and can be used as an effective alternative to FOB in low resource settings.
我们评估了在儿童仰卧位使用Air-QILA作为导管进行盲视经口气管插管的可行性，以及通过它在仰卧位和侧卧位使用纤维支气管镜（FOB）进行声门视图分级的可行性。
经伦理批准并获得同意后，60名儿童纳入本研究。在手术室，给所有儿童连接标准监测设备后，用七氟醚（2%-8%）加氧气（100%）诱导麻醉。待儿童镇静后，建立静脉通路并给予格隆溴铵（10μg·kg⁻¹）、芬太尼（2μg·kg⁻¹）和阿曲库铵（0.5mg·kg⁻¹）。3分钟后，将Air-QILA置于仰卧位，使用FOB在仰卧位和右侧卧位评估声门视图。记录所有儿童在两个不同体位的声门视图分级。之后将所有儿童转为仰卧位，通过Air-QILA进行盲视经口气管插管。记录成功率、Air-QILA的插入时间和气管插管情况。
57名儿童首次尝试成功放置Air-QILA，3名儿童需要第二次尝试。然而，通过Air-QILA进行的盲视气管插管首次尝试成功38名儿童，12名儿童需要第二次尝试。其余10名通过Air-QILA进行盲视气管插管仍未成功的儿童，进行了传统喉镜检查。在仰卧位和侧卧位，60例患者中分别有41例和38例可见1级声门视图。所有儿童从仰卧位转为侧卧位后，8名儿童声门视图分级恶化，2名儿童改善（P = 0.001）。
Air-QILA是一种易于放置的声门上气道装置，气道密封良好，气道并发症发生率低。它可作为仰卧位盲视经口气管插管的导管，在资源匮乏地区可作为FOB的有效替代方法。
