Moustafa Moustafa Abdelaziz, Arida Emad A, Zanaty Ola M, El-Tamboly Sameh Fathy
Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Antoniadis City Compound C2B7, Smouha, Alexandria, Egypt.
J Anesth. 2017 Dec;31(6):846-851. doi: 10.1007/s00540-017-2410-7. Epub 2017 Sep 21.
Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation.
This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups. All patients were subjected to the same anesthetic protocol. After full neuromuscular blockade, neck collar was removed and tracheal intubation was done in the neutral position. In group A, the trachea was intubated guided by a 5-12-MHz linear ultrasound probe attached to a Sonoscape A5 ultrasound machine. In group B, the trachea was intubated by an endotracheal tube mounted over a fiberscope (Karl Storz, working length 65 cm, distal tip diameter 5.6 mm). Hemodynamic measurements and oxygen saturation were recorded. Tracheal intubation criteria for both groups including duration of the intubation procedure, number of intubation attempts, success rate at each attempt, and the lowest oxygen saturation recorded during tracheal intubation were recorded.
Ultrasound and fiberscope achieved comparable time for tracheal intubation (57 ± 12 vs. 55 ± 10 s), respectively. Success rate of tracheal intubation at the first attempt was higher in the fiberscope group than the ultrasound group, with a P value of 0.032. The overall success rate was not significantly different between the two groups.
Ultrasound-guided tracheal intubation showed a lower first attempt success rate in patients with cervical spine immobilization compared to fiberscope-guided tracheal intubation but the overall success rates were comparable. Ultrasound can be an alternative technique for guiding tracheal intubation in patients with cervical spine immobilization.
PACTR201602001476292.
超声在麻醉期间气道管理中的应用日益广泛。本研究的目的是评估相对于纤维支气管镜引导下气管插管，实时超声引导下颈椎固定患者气管插管的可行性。
本随机对照研究对266例佩戴刚性颈托进行颈椎固定的成年患者进行，将其随机分为两组，每组人数相等。所有患者均采用相同的麻醉方案。在完全神经肌肉阻滞后，取下颈托，在中立位进行气管插管。A组在Sonoscape A5超声仪连接的5-12MHz线性超声探头引导下进行气管插管。B组通过安装在纤维支气管镜（Karl Storz，工作长度65cm，远端尖端直径5.6mm）上的气管导管进行气管插管。记录血流动力学指标和血氧饱和度。记录两组气管插管的标准，包括插管操作时间、插管尝试次数、每次尝试的成功率以及气管插管期间记录到的最低血氧饱和度。
超声和纤维支气管镜引导下气管插管的时间分别为（57±12）秒和（55±10）秒，二者相当。纤维支气管镜组首次气管插管成功率高于超声组，P值为0.032。两组的总体成功率无显著差异。
与纤维支气管镜引导下气管插管相比，超声引导下颈椎固定患者气管插管的首次尝试成功率较低，但总体成功率相当。超声可作为颈椎固定患者气管插管的替代技术。
PACTR201602001476292。
