Kılıçaslan Alper, Topal Ahmet, Erol Atilla, Uzun Sema Tuncer
Department of Anaesthesiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
Turk J Anaesthesiol Reanim. 2014 Aug;42(4):182-9. doi: 10.5152/TJAR.2014.59672. Epub 2014 Aug 1.
Recently, to further enhance the potential in the management of difficult airways, the highly angulated D-Blade was added to the C-MAC system. The purpose of this study was to investigate the laryngoscopic view and intubation parameters using the new C-MAC D-Blade in comparison to the conventional C-MAC video laryngoscope and Macintosh direct laryngoscope in simulated easy and difficult airways.
We recruited 26 experienced anaesthesia providers into a randomized trial. Each performed tracheal intubation of a Laerdal SimMan(®) manikin with each laryngoscope in the following laryngoscopy scenarios: (1) normal airway, (2) cervical spine immobilization, and (3) tongue edema. The intubation times, success rates, number of intubation attempts, laryngoscopic views, and severity of dental compression were recorded.
In all scenarios, video laryngoscopes provided better laryngeal exposure than the ML and appeared to produce less dental pressure. In the cervical spine immobilization scenario, D-Blade caused less dental pressure and showed better Cormack-Lehane (CL) classes than the other devices (p<0.001). There were no differences between video laryngoscopes in success of tracheal intubation (p>0.05). The CMAC provided the most rapid intubation. The rate of failure was 19% with ML. In the tongue edema scenario, the CMAC provided the most rapid and successful intubation (p<0.001). There were no differences between video laryngoscopes in laryngoscopic views according to CL classification and dental pressure (p>0.05). The rate of failure was 46% with the ML and 7% with the D-Blade.
The CMAC D-Blade caused less dental pressure than the conventional C-MAC and ML in the cervical immobilization scenario. The conventional CMAC performed better than the D-Blade and ML in the tongue edema scenario. These two video laryngoscopes may complement each other in various difficult airway situations.
最近，为了进一步提高处理困难气道的能力，C-MAC系统中增加了角度极大的D型喉镜。本研究的目的是在模拟的简单和困难气道中，将新型C-MAC D型喉镜与传统的C-MAC视频喉镜和麦金托什直接喉镜相比较，研究喉镜视野和插管参数。
我们招募了26名经验丰富的麻醉医生参与一项随机试验。每位医生在以下喉镜检查场景中使用每种喉镜对Laerdal SimMan®模拟人进行气管插管：（1）正常气道，（2）颈椎固定，（3）舌水肿。记录插管时间、成功率、插管尝试次数、喉镜视野以及牙齿受压的严重程度。
在所有场景中，视频喉镜比麦金托什喉镜提供了更好的喉部暴露，并且似乎产生的牙齿压力更小。在颈椎固定场景中，D型喉镜产生的牙齿压力更小，并且与其他设备相比，Cormack-Lehane（CL）分级更好（p<0.001）。视频喉镜在气管插管成功率方面没有差异（p>0.05）。C-MAC插管速度最快。麦金托什喉镜的失败率为19%。在舌水肿场景中，C-MAC插管速度最快且成功率最高（p<0.001）。根据CL分级，视频喉镜在喉镜视野和牙齿压力方面没有差异（p>0.05）。麦金托什喉镜的失败率为46%，D型喉镜为7%。
在颈椎固定场景中，C-MAC D型喉镜比传统的C-MAC和麦金托什喉镜产生的牙齿压力更小。在舌水肿场景中，传统的C-MAC比D型喉镜和麦金托什喉镜表现更好。这两种视频喉镜在各种困难气道情况下可能相互补充。
