Gu Yuqi, Robert Joshua, Kovacs George, Milne Andrew D, Morris Ian, Hung Orlando, MacQuarrie Kirk, Mackinnon Sean, Adam Law J
Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
Can J Anaesth. 2016 Aug;63(8):928-37. doi: 10.1007/s12630-016-0654-6. Epub 2016 Apr 18.
During video laryngoscopy (VL) with angulated or hyper-curved blades, it is sometimes difficult to complete tracheal intubation despite a full view of the larynx. When using indirect VL, it has been suggested that it may be preferable to obtain a deliberately restricted view of the larynx to facilitate passage of the endotracheal tube. We used the GlideScope® GVL video laryngoscope (GVL) to test whether deliberately obtaining a restricted view would result in faster and easier tracheal intubation than with a full view of the larynx.
We recruited 163 elective surgical patients and randomly allocated the participants to one of two groups: Group F, where a full view of the larynx was obtained and held during GVL-facilitated tracheal intubation, and Group R, with a restricted view of the larynx (< 50% of glottic opening visible). Study investigators experienced in indirect VL performed the intubations. The intubations were recorded and the video recordings were subsequently assessed for total time to intubation, ease of intubation using a visual analogue scale (VAS; where 0 = easy and 100 = difficult), first-attempt success rate, and oxygen saturation after intubation. Complications were also assessed.
The median [interquartile range (IQR)] time to intubation was faster in Group R than in Group F (27 [22-36] sec vs 36 [27-48] sec, respectively; median difference, 9 sec; 95% confidence interval [CI], 5 to 13; P < 0.001). The median [IQR] VAS rating for ease of intubation was also better in Group R than in Group F (14 [6-42) mm vs 50 mm [17-65], respectively; median difference, 20 mm; 95% CI, 10 to 31; P < 0.001). There was no difference between groups regarding the first-attempt success rate, oxygen saturation immediately after intubation, or complications.
Using the GVL with a deliberately restricted view of the larynx resulted in faster and easier tracheal intubation than with a full view and with no additional complications. Our study suggests that obtaining a full or Cormack-Lehane grade 1 view may not be desirable when using the GVL. This trial was registered at ClinicalTrials.gov: NCT02144207.
在使用成角或极度弯曲喉镜叶片进行视频喉镜检查（VL）时，尽管能完全看清喉部，但有时仍难以完成气管插管。在使用间接视频喉镜检查时，有人提出刻意限制对喉部的视野可能更有利于气管导管的通过。我们使用GlideScope® GVL视频喉镜（GVL）来测试刻意获得受限视野是否比完全看清喉部能更快、更轻松地完成气管插管。
我们招募了163例择期手术患者，并将参与者随机分为两组：F组，在GVL辅助气管插管过程中获得并保持对喉部的完全视野；R组，对喉部的视野受限（可见声门开口小于50%）。由间接视频喉镜检查经验丰富的研究人员进行插管操作。插管过程进行记录，随后对视频记录评估气管插管总时间、使用视觉模拟评分法（VAS；0表示容易，100表示困难）评估插管难易程度、首次尝试成功率以及插管后的血氧饱和度。还对并发症进行了评估。
R组气管插管的中位[四分位间距（IQR）]时间比F组更快（分别为27 [22 - 36]秒和36 [27 - 48]秒；中位差异为9秒；95%置信区间[CI]为5至13；P < 0.001）。R组插管难易程度的中位[IQR] VAS评分也优于F组（分别为14 [6 - 42]毫米和50毫米[17 - 65]；中位差异为20毫米；95% CI为10至31；P < 0.001）。两组在首次尝试成功率、插管后即刻血氧饱和度或并发症方面无差异。
使用GVL时刻意限制对喉部的视野比完全看清喉部能更快、更轻松地完成气管插管，且无额外并发症。我们的研究表明，使用GVL时可能无需获得完全视野或Cormack - Lehane 1级视野。本试验已在ClinicalTrials.gov注册：NCT02144207。
