一项随机交叉研究，比较模拟颈椎固定患者在两种光棒插管技术插管过程中的颈椎活动：喉镜辅助光棒插管与传统光棒插管。

A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation.

作者信息

Kim Tae Kyong, Son Je-Do, Seo Hyungseok, Lee Yun-Seok, Bae Jinyoung, Park Hee-Pyoung

机构信息

From the *Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; †Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea; and ‡Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.

出版信息

Anesth Analg. 2017 Aug;125(2):485-490. doi: 10.1213/ANE.0000000000001813.

DOI:10.1213/ANE.0000000000001813

PMID:28244946

Abstract

BACKGROUND

In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization.

METHODS

In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation.

RESULTS

Cervical spine motion at the occiput-C1 segment was 5.6° (4.3) and 9.3° (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8° [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1° [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2° [-2.8 to 2.5]; P = .795 in the C2-C5 segment).

CONCLUSIONS

The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization.

摘要

背景

在颈椎固定的患者中，托颌法可导致颈椎移动。同时使用喉镜可能有助于光棒插管，使光棒在口腔内中线放置并自由移动而无需托颌法。我们比较了喉镜辅助光棒插管（LALI）与传统光棒插管（CLI）在模拟颈椎固定患者插管过程中对颈椎运动的影响。

方法

在这项随机交叉研究中，对20例接受LALI和CLI技术插管的模拟颈椎固定患者，在枕骨-C1、C1-C2和C2-C5节段插管前和插管过程中测量颈椎角度。颈椎运动定义为插管过程中每个颈椎节段测量角度相对于基线的变化。

结果

使用LALI和CLI技术时，枕骨-C1节段的颈椎运动分别为5.6°（4.3）和9.3°（4.5）（平均差异[98.33%CI]；-3.8°[-7.2至-0.3]；P = 0.007）。在其他颈椎节段，两种技术之间无显著差异（C1-C2节段为-0.1°[-2.6至2.5]；P = 0.911；C2-C5节段为-0.2°[-2.8至2.5]；P = 0.795）。