Castillo-Monzón Caridad G, Marroquín-Valz Hugo A, Fernández-Villacañas-Marín Miguel, Moreno-Cascales Matilde, García-Rojo Blas, Candia-Arana César A
Service of Anesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, Murcia, Spain.
J Clin Anesth. 2017 Feb;36:136-141. doi: 10.1016/j.jclinane.2016.10.023. Epub 2016 Dec 2.
Morbid obesity is associated with a difficult management of the airway. There is no agreement on these patients being difficult to intubate, but if they are difficult to ventilate with facial mask, then the fast control of their airway becomes a priority. This study compares the quickness and success in tracheal intubation, glottic view, hemodynamic response, and complications from the use of the Macintosh and Airtraq laryngoscopes in morbidly obese patients for scheduled surgery.
Prospective, observational, and randomized study.
Operating room.
Forty-six American Society of Anesthesiologists III patients.
Patients were randomly assigned to undergo tracheal intubation using a Macintosh (n=23) or an Airtraq laryngoscope (n=23).
The following were compared: intubation time, laryngeal vision, the necessity of additional maneuvers to carry out the tracheal intubation, the success of the maneuvers, complications, and hemodynamic response.
The preoperative conditions of the studied patients were similar in both groups. The average time of the intubation was 17.27±16.1 seconds and 22.11±13.62 seconds in the Airtraq and Macintosh groups, respectively (P=.279). With the Airtraq device, 95.65% of patients presented a glottic view 1 and 2a (P=.006) and less optimizing maneuvers were needed to perform the tracheal intubation (P=.001). There were no cases of difficult intubation, failed intubation, or difficult ventilation. A statistically significant increase in the heart rate was detected with the use of the Macintosh laryngoscope. A patient with redundant epiglottis could not be intubated with the Airtraq laryngoscope.
Both devices allow quick and safe management of the airway. The Airtraq laryngoscope improved the glottic view by the modified Cormack-Lehane classification, reduced the need for additional maneuvers for tracheal intubation, and also reduced the degree of sympathetic stimulus detected by a minor increase in heart rate after tracheal intubation.
病态肥胖与气道管理困难相关。对于这些患者是否难以插管尚无定论，但如果他们难以通过面罩通气，那么快速控制气道就成为首要任务。本研究比较了在择期手术的病态肥胖患者中使用麦金托什喉镜和Airtraq喉镜进行气管插管的速度、成功率、声门视野、血流动力学反应及并发症情况。
前瞻性、观察性、随机研究。
手术室。
46例美国麻醉医师协会Ⅲ级患者。
患者被随机分配使用麦金托什喉镜（n = 23）或Airtraq喉镜（n = 23）进行气管插管。
比较以下各项：插管时间、喉镜视野、进行气管插管所需额外操作的必要性、操作成功率、并发症及血流动力学反应。
两组研究患者的术前情况相似。Airtraq组和麦金托什组的平均插管时间分别为17.27±16.1秒和22.11±13.62秒（P = 0.279）。使用Airtraq设备时，95.65%的患者呈现声门视野1级和2a级（P = 0.006），且进行气管插管所需的优化操作较少（P = 0.001）。未出现插管困难、插管失败或通气困难的病例。使用麦金托什喉镜时检测到心率有统计学意义的升高。一名会厌冗长的患者无法使用Airtraq喉镜进行插管。
两种设备都能实现快速、安全的气道管理。Airtraq喉镜根据改良的科马克-莱汉内分类法改善了声门视野，减少了气管插管所需的额外操作，并且通过气管插管后心率的轻微升高所检测到的交感神经刺激程度也有所降低。
