Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna General Hospital, Vienna, Austria -
Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Minerva Anestesiol. 2017 Aug;83(8):798-803. doi: 10.23736/S0375-9393.17.11537-3. Epub 2017 Jan 17.
Vocal cords visualization is a major determinant for successful tracheal intubation. The aim of our study was to compare vocal cord visualization by using conventional direct laryngoscopy with retromolar direct laryngoscopy in patients with an existing retromolar gap at the right mandible.
We enrolled 100 adults needing endotracheal intubation for elective surgery. In each patient, the vocal cords were visualized and scored according to Cormack and Lehane with a Macintosh blade #3 for conventional technique and with a Miller blade #4 for the retromolar technique in a randomized sequence. Finally, tracheal intubation was performed primarily by conventional laryngoscopy and in the case of failing retromolar laryngoscopy was used as the rescue method.
Overall 100 laryngoscopies with the conventional method and 100 laryngoscopies with the retromolar method were scored according to Cormack and Lehane. The retromolar technique achieved significant (P=0.000003) lower Cormack and Lehane scores compared to the conventional technique. In eleven patients, intubation by conventional laryngoscopy failed and seven of those patients were successfully intubated by the retromolar technique. A BURP-maneuver significantly improved vocal cord visualization during both methods.
In summary, laryngoscopy via the retromolar method by using a Miller blade #4 lead to a significantly better vocal cord visualization compared to the conventional method performed with a Macintosh blade #3 in patients with an existing retromolar gap on the right side.
声带可视化是气管插管成功的主要决定因素。我们的研究目的是比较下颌右侧存在磨牙后间隙的患者中使用常规直接喉镜和磨牙后直接喉镜进行声带可视化的效果。
我们纳入了 100 名需要进行择期手术的气管插管的成年人。在每位患者中，使用 Macintosh 刀片#3 进行常规技术和使用 Miller 刀片#4 进行磨牙后技术，按照 Cormack 和 Lehane 标准对声带进行可视化和评分，并以随机顺序进行。最后，通过常规喉镜进行气管插管，如果磨牙后喉镜插管失败，则使用作为救援方法。
总共对 100 次常规方法的喉镜检查和 100 次磨牙后方法的喉镜检查进行了 Cormack 和 Lehane 评分。与常规技术相比，磨牙后技术的 Cormack 和 Lehane 评分明显较低（P=0.000003）。在 11 例患者中，常规喉镜插管失败，其中 7 例患者通过磨牙后技术成功插管。BURP 手法在两种方法中均显著改善了声带可视化。
总之，与使用 Macintosh 刀片#3 进行的常规方法相比，使用 Miller 刀片#4 通过磨牙后方法进行喉镜检查可显著改善右侧存在磨牙后间隙的患者的声带可视化效果。
