Liu Zi-Jia, Yi Jie, Guo Wen-Juan, Ma Chao, Huang Yu-Guang
From the Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Science, Dongcheng District, Beijing, China (Z-JL, JY, W-JG, Y-GH) and Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China (CM).
Medicine (Baltimore). 2016 Jan;95(2):e2514. doi: 10.1097/MD.0000000000002514.
Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack-Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack-Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation.
在当前麻醉实践中，困难插管和插管失败是发病和死亡的主要原因。包括麦格拉斯3系列视频喉镜在内的几种设备可供使用，与麦金托什喉镜相比，这些设备可能通过改善喉部视野来促进气管插管。但目前尚无研究表明，在经验不足的麻醉医生进行正常气道插管时，麦格拉斯3系列是否比麦金托什喉镜表现更好。因此，我们设计了这项随机对照研究，以比较经验不足的麻醉医生在常规气管插管中使用麦格拉斯喉镜和麦金托什喉镜的效果。
总共180例气道外观正常、需要接受择期手术经口气管插管的成年患者被随机分配，由9名经验不足的麻醉医生分别使用麦格拉斯喉镜或麦金托什喉镜进行插管。主要结局指标是插管时间。采用5分序数量表评估插管的难易程度。记录插管尝试/失败情况、使用科马克-莱哈尼分级评估的最佳喉镜视野、相关并发症以及插管期间的血流动力学变化。
我们发现，麦格拉斯喉镜和麦金托什喉镜在插管中位时间上无显著差异（P = 0.46）；使用麦格拉斯喉镜获得的科马克-莱哈尼视野更佳（P < 0.001）；插管难易程度的差异具有统计学意义（P = 0.01）。两组均未发生严重创伤。两组间收缩压变化存在统计学显著差异（P < 0.05）。
我们证明，对于经验不足的麻醉医生在气道正常的患者进行经口气管插管时，与麦金托什喉镜相比，麦格拉斯喉镜能提供更好的声门视野、更高的插管成功率、更少的并发症以及血流动力学变化，且插管时间不逊色。在简单插管中，它仍是经验不足的麻醉医生的一个潜在选择。
