Xu Mao, Li Xiao-Xi, Guo Xiang-Yang, Wang Jun
Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China.
Department of Anesthesiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
Chin Med J (Engl). 2017 Feb 5;130(3):297-302. doi: 10.4103/0366-6999.198926.
Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis.
A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III-IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test.
The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P< 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034).
SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway.
Chinese Clinical Trial Registry, ChiCTR-IOR-16007821; http://www.chictr.org.cn/showproj.aspx?proj=13203.
气道管理对于颈椎病患者至关重要，这类患者气道困难发生率较高。使用希卡尼可视探条（SOS）进行气管插管在困难气道管理中越来越普遍。我们比较了SOS与麦金托什喉镜（MLS）在颈椎病手术患者中气管插管的效果。
选取2012年8月至2016年1月计划行脊髓型和神经根型颈椎病择期手术的270例患者，通过随机数字法将其随机分为MLS组或SOS组。术前对患者进行困难气道评估，并在麻醉诱导期间确定科马克-莱汉内喉镜分级。困难气道定义为科马克-莱汉内Ⅲ-Ⅳ级。使用随机分配的插管设备对患者进行气管插管。记录成功率、插管时间、所需辅助情况、即刻并发症及术后不适。分类变量采用卡方检验分析，连续变量采用独立样本t检验或秩和检验分析。
两组正常气道患者的插管成功率均为100%。在困难气道患者中，MLS组和SOS组的成功率分别为84.2%和94.1%（P = 0.605）。与MLS相比，SOS插管时间更长（正常气道：25.1±5.8秒对24.5±5.7秒，P = 0.426；困难气道：38.5±8.5秒对36.1±8.2秒，P = 0.389）。在困难气道患者中，SOS插管所需辅助较少（5.9%对100%，P<0.001）。正常气道患者中，SOS组术后咽痛发生率低于MLS组（22.0%对34.5%，P = 0.034）。
SOS是颈椎病手术患者安全有效的气道管理设备。与MLS相比，SOS在临床上对插管有益，尤其是在困难气道患者中。
中国临床试验注册中心ChiCTR-IOR-16007821；http://www.chictr.org.cn/showproj.aspx?proj=13203
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