Ishida Takashi, Kiuchi Chiaki, Sekiguchi Takemi, Tsujimoto Takatoshi, Kawamata Mikito
From the Department of Anaesthesiology and Resuscitation, Shinshu University School of Medicine, Matsumoto, Japan.
Eur J Anaesthesiol. 2016 Apr;33(4):263-8. doi: 10.1097/EJA.0000000000000367.
Transoesophageal echocardiography (TOE) probe insertion in anaesthetised patients can cause pharyngeal and oesophageal injuries. Kim et al. have shown that insertion assisted by a Macintosh laryngoscope can reduce such complications but it may sometimes be difficult to observe the passage of a TOE probe. The McGRATH MAC (McGRATH) has been shown to provide a better view of the glottis, piriform fossa and oesophageal inlet during tracheal intubation than the Macintosh.
We hypothesised that the McGRATH provided better visualisation of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to insertion, compared with the Macintosh.
A randomised controlled trial.
The study was conducted in a university hospital from February to December 2014.
One hundred patients undergoing elective surgery under intraoperative TOE monitoring were randomised to either a Macintosh group or a McGRATH group.
Macintosh and McGRATH were used to visualise the passage of the TOE probe and guide its insertion.
Visibility of the oesophageal inlet, the number of TOE insertion attempts and incidence of pharyngeal mucosal injury after the TOE probe had been removed were assessed.
The percentage of patients in whom the oesophageal inlet was visible was higher in the McGRATH group (88%) than in the Macintosh group (41%) (P < 0.01). The number of TOE probe insertion attempts was significantly smaller in the McGRATH group than in the Macintosh group (P = 0.039). The incidence of pharyngeal mucosal injury was significantly smaller in the McGRATH group (4%) than in the Macintosh group (16%; P = 0.042).
The McGRATH provided a better view of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to its insertion.
University Hospital Medical Information Network in Japan (UMIN) 000012970.
在麻醉患者中插入经食管超声心动图（TOE）探头可导致咽部和食管损伤。Kim等人表明，在麦金托什喉镜辅助下插入可减少此类并发症，但有时难以观察到TOE探头的通过情况。已证明麦格拉思MAC喉镜（McGRATH）在气管插管期间比麦金托什喉镜能更好地观察声门、梨状窝和食管入口。
我们假设与麦金托什喉镜相比，McGRATH能更好地观察食管入口，有助于TOE探头放置，可能降低与插入相关的咽部损伤发生率。
一项随机对照试验。
该研究于2014年2月至12月在一家大学医院进行。
100例在术中TOE监测下接受择期手术的患者被随机分为麦金托什组或McGRATH组。
使用麦金托什喉镜和McGRATH喉镜观察TOE探头的通过情况并指导其插入。
评估食管入口的可视性、TOE探头插入尝试次数以及TOE探头取出后咽部黏膜损伤的发生率。
McGRATH组中食管入口可见的患者百分比（88%）高于麦金托什组（41%）（P<0.01）。McGRATH组的TOE探头插入尝试次数明显少于麦金托什组（P=0.039）。McGRATH组的咽部黏膜损伤发生率（4%）明显低于麦金托什组（16%；P=0.042）。
McGRATH能更好地观察食管入口，有助于TOE探头放置，可能降低与插入相关的咽部损伤发生率。
日本大学医院医学信息网络（UMIN）000012970。
