Shravanalakshmi Dhanyasi, Bidkar Prasanna U, Narmadalakshmi K, Lata Suman, Mishra Sandeep K, Adinarayanan S
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Surg Neurol Int. 2017 Feb 6;8:19. doi: 10.4103/2152-7806.199560. eCollection 2017.
Glottic visualization can be difficult with cervical immobilization in patients with cervical spine injury. Indirect laryngoscopes may provide better glottic visualization in these groups of patients. Hence, we compared King Vision videolaryngoscope, C-MAC videolaryngoscope for endotracheal intubation in patients with proven/suspected cervical spine injury.
After standard induction of anesthesia, 135 patients were randomized into three groups: group C (conventional C-MAC videolaryngoscope), group K (King Vision videolaryngoscope), and group D (D blade C-MAC videolaryngoscope). Cervical immobilization was maintained with Manual in line stabilization with anterior part of cervical collar removed. First pass intubation success, time for intubation, and glottic visualization (Cormack - Lehane grade and percentage of glottic opening) were noted. Intubation difficulty score (IDS) was used for grading difficulty of intubation. Five-point Likert scale was used for ease of insertion of laryngoscope.
First attempt success rate were 100% (45/45), 93.3% (42/45), and 95.6% (43/45) in patients using conventional C-MAC, King Vision, and D blade C-MAC videolaryngoscopes, respectively. Time for intubation in seconds was significantly faster with conventional C-MAC videolaryngoscope (23.3 ± 4.7) compared to D blade C-MAC videolaryngoscope (26.7 ± 7.1), whereas conventional C-MAC and King Vision were comparable (24.9 ± 7.2). Good grade glottic visualization was obtained with all the three videolaryngoscopes.
All the videolaryngoscopes provided good glottic visualization and first attempt success rate. Conventional C-MAC insertion was significantly easier. We conclude that all the three videolaryngoscopes can be used effectively in patients with cervical spine injury.
颈椎损伤患者在颈椎固定的情况下，声门可视化可能会有困难。间接喉镜可能会为这类患者提供更好的声门可视化效果。因此，我们比较了King Vision视频喉镜、C-MAC视频喉镜在已证实/疑似颈椎损伤患者气管插管中的应用。
在标准麻醉诱导后，135例患者被随机分为三组：C组（传统C-MAC视频喉镜）、K组（King Vision视频喉镜）和D组（D型叶片C-MAC视频喉镜）。通过手动直线固定法维持颈椎固定，同时移除颈托前部。记录首次插管成功率、插管时间和声门可视化情况（Cormack-Lehane分级和声门开口百分比）。使用插管困难评分（IDS）对插管难度进行分级。采用五点李克特量表评估喉镜插入的难易程度。
使用传统C-MAC、King Vision和D型叶片C-MAC视频喉镜的患者首次尝试成功率分别为100%（45/45）、93.3%（42/45）和95.6%（43/45）。传统C-MAC视频喉镜的插管时间（23.3±4.7秒）明显快于D型叶片C-MAC视频喉镜（26.7±7.1秒），而传统C-MAC和King Vision相当（24.9±7.2秒）。三种视频喉镜均获得了良好的声门可视化效果。
所有视频喉镜均提供了良好的声门可视化效果和首次尝试成功率。传统C-MAC插入明显更容易。我们得出结论，三种视频喉镜均可有效用于颈椎损伤患者。
