Priyanka Anto Sahaya, Nag Kusha, Hemanth Kumar V R, Singh Dewan Roshan, Kumar Senthil, Sivashanmugam T
Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India.
Anesth Essays Res. 2017 Jan-Mar;11(1):238-242. doi: 10.4103/0259-1162.200240.
Visualization of vocal cords following extubation after thyroid and major neck surgeries is highly desirable for the surgeon as well as the anaesthesiologist to rule out vocal cord palsy or oedema. As the patient is emerging from general anaesthesia, it may be challenging for the anaesthesiologist to optimally visualise and grade vocal cord movement following extubation.
Randomized clinical trial at a tertiary care centre.
After obtaining institutional ethics committee approval, 60 patients posted for thyroid and major neck surgeries under American Society of Anesthesiologists (ASA) grade I and II were recruited for the study. Written informed consent was obtained. Pre-operatively indirect laryngoscopy was performed in all the patients to assess baseline vocal cord function. All patients were premedicated and induced and maintained as per standardized anaesthesia protocol. Patients were randomized using a sealed envelope technique to either Group K where intubation was performed using Kings vision laryngoscope or Group T where intubation was performed using True view laryngoscope. Glottis visualization was graded in all patients and intubated. Ten minutes prior to extubation injection. dexmedetomidine 1 μg/kg was administered. Once patients satisfied extubation criteria, laryngoscopy was performed using respective video-laryngoscope in each group, patient extubated under vision and assessed for vocal cord visualization and mobility grade (VMG) and patient reactivity score (PRS). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was also noted. Total intraoperative morphine consumption was recorded. Vocal cord function was assessed again before the day of discharge by indirect laryngoscopy.
Age ( = 0.27), sex ( = 0.08), body mass index ( = 0.70), ASA ( = 0.39), mallampati class ( = 0.72) and morphine used ( = 0.39) were comparable in both groups. There was no statistically significant difference among the two groups with respect to VMG ( = 0.18). There was no statistical difference in the PRS ( = 0.06) in both groups. Increase in heart rate or mean arterial pressure from baseline was not significant statistically in both groups. Time taken for laryngoscopy during extubation was significantly less with group T as compared to group K ( = 0.000).
Both Kings Vision and Truview Video-laryngoscopes provide comparable laryngoscopic view with similar patient comfort, although clinically Truview may be a better choice due to less time consumed for visualisation and rating vocal cord movement during extubation.
甲状腺及颈部大手术后拔管后声带的可视化，对外科医生和麻醉医生来说，对于排除声带麻痹或水肿非常必要。当患者从全身麻醉中苏醒时，麻醉医生要想在拔管后最佳地可视化并分级评估声带运动可能具有挑战性。
一家三级医疗中心的随机临床试验。
在获得机构伦理委员会批准后，招募了60例拟行甲状腺及颈部大手术、美国麻醉医师协会（ASA）分级为I级和II级的患者进行研究。获得了书面知情同意书。所有患者术前均行间接喉镜检查以评估基线声带功能。所有患者均按照标准化麻醉方案进行术前用药、诱导和维持麻醉。患者采用密封信封技术随机分为K组，使用King视喉镜进行插管；T组，使用True视喉镜进行插管。对所有患者的声门可视化情况进行分级并插管。拔管前10分钟注射右美托咪定1μg/kg。一旦患者符合拔管标准，每组使用各自的视频喉镜进行喉镜检查，在直视下为患者拔管，并评估声带可视化及活动度分级（VMG）和患者反应评分（PRS）。同时记录心率、收缩压、舒张压和平均动脉压。记录术中吗啡总用量。出院前一天再次通过间接喉镜检查评估声带功能。
两组患者的年龄（P = 0.27）、性别（P = 0.08）、体重指数（P = 0.70）、ASA分级（P = 0.39）、Mallampati分级（P = 0.72）和吗啡用量（P = 0.39）具有可比性。两组在VMG方面无统计学显著差异（P = 0.18）。两组在PRS方面无统计学差异（P = 0.06）。两组患者心率或平均动脉压较基线的升高在统计学上均无显著意义。与K组相比，T组拔管时喉镜检查所用时间显著更短（P = 0.000）。
King视喉镜和True视视频喉镜提供的喉镜视野相当，患者舒适度相似，不过从临床角度看，由于拔管时可视化及评估声带运动所用时间较少，True视喉镜可能是更好的选择。
