Tseng Kuang-Yi, Lu I-Cheng, Shen Ya-Chun, Lin Chia-Heng, Chen Po-Nien, Cheng Kuang-I
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Anesthesiology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Asian J Anesthesiol. 2017 Mar;55(1):17-21. doi: 10.1016/j.aja.2017.05.006. Epub 2017 Jun 8.
Nasotracheal intubation (NTI) is usually required in patients undergoing maxillofacial surgery. Though video-scopes have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning NTI. The aim of the study is to compare the efficiency of video-scopes and the traditional direct laryngoscopy in NTI. One hundred and eight patients scheduled for elective oro-maxillofacial surgery under nasotracheal intubation general anesthesia were randomly allocated into one of 3 groups of GlideScope, Pentax AirWay Scope, or Macintosh laryngoscope respectively. The primary outcome measures were total intubation time and each separate time interval (time A: for placement for the nasotracheal tube from selected nostril to oropharynx; time B: for use of devices to view the glottic opening; time C: for advancing nasotracheal tube from oropharynx into trachea and removing the scope from the oral cavity). The secondary outcomes were measurement of scores of modified naso-intubation difficulty scale (MNIDS) and attempts at intubation.
Mean total intubation time and time C interval were taken with GlideScope (33.1 s and 9.7 s), Pentax (38.4 s and 12.9 s), and Macintosh (42.2 s and 14.9 s) respectively. There was a significant difference among the groups (total time, P = 0.03; time C, P = 0.02). The median score of MNIDS was significantly lower using GlideScope or Pentax compared with using Macintosh in NTI (P = 0.037) and difficult intubation grading by MNIDS presented as easier in the GlideScope group than in the Macintosh group (0.016). Using GlideScope, intubation was successful at the first attempt in 80% patients whereas only 65% and 72.5% with the Pentax and Macintosh (P = 0.02).
As compared with the Macintosh laryngoscope, the GlideScope video laryngoscope facilitated nasotracheal intubations with shortened intubation time and reduced intubation difficulty in patients undergoing oromaxillofacial surgery.
颌面外科手术患者通常需要经鼻气管插管（NTI）。尽管视频喉镜已被证明在口腔气管插管中表现良好，但关于经鼻气管插管的信息有限。本研究的目的是比较视频喉镜和传统直接喉镜在经鼻气管插管中的效率。108例计划在经鼻气管插管全身麻醉下进行择期口腔颌面外科手术的患者被随机分为三组，分别使用GlideScope视频喉镜、宾得气道镜或麦金托什喉镜。主要观察指标为总插管时间和各个单独的时间间隔（时间A：将鼻气管导管从选定鼻孔插入口咽的时间；时间B：使用器械观察声门开口的时间；时间C：将鼻气管导管从口咽推进气管并从口腔取出喉镜的时间）。次要观察指标为改良经鼻插管困难量表（MNIDS）评分及插管尝试次数。
使用GlideScope视频喉镜、宾得气道镜和麦金托什喉镜时，平均总插管时间和时间C间隔分别为（33.1秒和9.7秒）、（38.4秒和12.9秒）和（42.2秒和14.9秒）。各组之间存在显著差异（总时间，P = 0.03；时间C，P = 0.02）。在经鼻气管插管中，使用GlideScope视频喉镜或宾得气道镜时MNIDS的中位数评分显著低于使用麦金托什喉镜（P = 0.037），且根据MNIDS进行的困难插管分级显示，GlideScope组比麦金托什组更容易（0.016）。使用GlideScope视频喉镜时，80%的患者首次插管成功，而使用宾得气道镜和麦金托什喉镜时分别为65%和72.5%（P = 0.02）。
与麦金托什喉镜相比，GlideScope视频喉镜在口腔颌面外科手术患者的经鼻气管插管中缩短了插管时间，降低了插管难度。
