经 King Vision™ 可视喉镜与普通喉镜行气管插管时颈椎活动的对比随机研究。

Cervical spine motion during tracheal intubation with King Vision™ video laryngoscopy and conventional laryngoscopy: a crossover randomized study.

机构信息

Department of Anesthesiology, King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia.

Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura, Egypt.

出版信息

Minerva Anestesiol. 2017 Nov;83(11):1152-1160. doi: 10.23736/S0375-9393.17.11913-9. Epub 2017 Jun 12.

DOI:10.23736/S0375-9393.17.11913-9

PMID:28607336

Abstract

BACKGROUND

The King Vision™ (KVL) videolaryngoscope with a wide field of view could potentially reduce cervical spine motion during intubation. We aimed to compare the extent of cervical spine movement during laryngoscopy using the KVL and Macintosh laryngoscopes.

METHODS

Following ethical approval, 29 patients with a normal cervical spine requiring general anesthesia and tracheal intubation were randomly subjected to both KVL and Macintosh laryngoscopy in a crossover. Cervical spine motion during each laryngoscopy was radiologically examined by measuring changes in cumulative spine motion and changes from the neutral position in the C0-C5 angles formed by the adjacent vertebrae. Time to tracheal intubation, laryngoscopic view, and ease of intubation were also recorded.

RESULTS

Compared with direct laryngoscopy, the KVL resulted in significantly less movement of the C-spine at the C0-C1, and C3-C4, C4-C5 segments (mean differences: C0-C1: 3.01 ° [95% CI: -4.74° to -1.28°]; C3-C4: 1.81° [95% CI: -3.19° to -0.43°]; C4-C5: -0.88° [95% CI: -1.61° to -0.19°], P<0.02) and cumulative C-spine movement (mean 36.1˚[95% CI 32.72 to 39.51] vs. 44.1˚[95%CI: 39.54 to 48.75]; P=0.001). There was significant movement in the C0-C3 segment from baseline using both devices. Tracheal intubation took longer with KVL (mean difference: 12.7 s [95% CI: 9.15 to 16.13 s]; P=0.001) even though laryngeal visualization was improved (Cormack Lehane Grade I was reported in 100% KVL vs. 65.5% Macintosh laryngoscopies; P=0.001).

CONCLUSIONS

In patients with normal cervical spine, KVL resulted in less extension of the cervical spine than direct laryngoscopy.

摘要

背景

视野宽阔的 King Vision™（KVL）视频喉镜在插管过程中可能会减少颈椎运动。我们旨在比较 KVL 和 Macintosh 喉镜在喉镜检查过程中颈椎运动的程度。

方法

在获得伦理批准后，29 名需要全身麻醉和气管插管的颈椎正常患者以交叉方式随机接受 KVL 和 Macintosh 喉镜检查。通过测量相邻椎骨形成的 C0-C5 角中累积脊柱运动的变化和从中立位置的变化，放射学检查每次喉镜检查过程中的颈椎运动。还记录了气管插管时间、喉镜视野和插管的难易程度。

结果

与直接喉镜相比，KVL 导致 C0-C1 和 C3-C4、C4-C5 节段的颈椎运动明显减少（平均差异：C0-C1：3.01°[95%CI：-4.74°至-1.28°]；C3-C4：1.81°[95%CI：-3.19°至-0.43°]；C4-C5：-0.88°[95%CI：-1.61°至-0.19°]，P<0.02）和累积颈椎运动（平均 36.1˚[95%CI 32.72 至 39.51] 与 44.1˚[95%CI：39.54 至 48.75]；P=0.001）。两种器械均从基线开始 C0-C3 节段出现明显运动。使用 KVL 进行气管插管的时间更长（平均差异：12.7 s [95%CI：9.15 至 16.13 s]；P=0.001），尽管喉镜检查的可视化得到了改善（100%的 KVL 报告 Cormack Lehane 分级 I，而 Macintosh 喉镜检查为 65.5%；P=0.001）。