Jain Divya, Mehta Swati, Gandhi Komal, Arora Suman, Parikh Badal, Abas Muneer
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Paediatr Anaesth. 2018 Mar;28(3):226-230. doi: 10.1111/pan.13316. Epub 2018 Jan 9.
Endotracheal intubation in lateral position in infants is a challenge. This difficulty may be surmounted to some extent by using videolaryngoscopes but the routine use of these devices as a tool to secure the airway in lateral position remains unevaluated. Therefore, we conducted a prospective, randomized controlled trial to compare the intubation conditions achieved with the CMAC videolaryngoscope and the Miller Laryngoscope in lateral position in infants. We hypothesized that CMAC videolaryngoscope would provide a better laryngoscopic view and reduce the time to intubation compared to the Miller blade.
Sixty-four children aged <1 year, belonging to American Society of Anesthesiologists physical status I-III requiring endotracheal intubation were randomized to undergo tracheal intubation with either the Miller laryngoscope (n = 32) or the CMAC videolaryngoscope (n = 32) in left lateral position. Anesthesia was induced with sevoflurane or thiopentone 5-8 mg/kg IV and atracurium 0.5 mg/kg IV. Total time taken to intubate was assessed as the primary outcome. Laryngoscopic view, intubation difficulty score, success rate of tracheal intubation, number of attempts, maneuvers used, and any airway complications were recorded as secondary outcomes.
The difference in the mean time to intubate (95% confidence interval) between the Miller and CMAC group was 6.1 (1.7-10.4) seconds. Furthermore, the CMAC videolaryngoscope provided a better laryngoscopic view compared to the conventional Miller blade. In addition, the Intubation Difficulty Scale score was less in the CMAC videolaryngoscope group.
The CMAC videolaryngoscope decreases the time taken to intubate and reduces the intubation difficulty when compared to the Miller laryngoscope. Therefore, the CMAC videolaryngoscope may be more useful device when intubating the trachea of infants in the lateral position.
婴儿侧卧位气管插管具有挑战性。使用视频喉镜在一定程度上可以克服这一困难，但这些设备作为确保侧卧位气道安全的工具的常规使用情况仍未得到评估。因此，我们进行了一项前瞻性随机对照试验，比较CMAC视频喉镜和米勒喉镜在婴儿侧卧位时的插管条件。我们假设与米勒喉镜相比，CMAC视频喉镜能提供更好的喉镜视野并缩短插管时间。
64名年龄小于1岁、美国麻醉医师协会身体状况为I - III级且需要气管插管的儿童被随机分为两组，分别使用米勒喉镜（n = 32）或CMAC视频喉镜（n = 32）在左侧卧位下行气管插管。采用七氟醚或硫喷妥钠5 - 8mg/kg静脉注射及阿曲库铵0.5mg/kg静脉注射诱导麻醉。将插管总时间作为主要观察指标进行评估。记录喉镜视野、插管困难评分、气管插管成功率、尝试次数、使用的操作方法以及任何气道并发症作为次要观察指标。
米勒组和CMAC组平均插管时间（95%置信区间）的差异为6.1（1.7 - 10.4）秒。此外，与传统的米勒喉镜相比，CMAC视频喉镜提供了更好的喉镜视野。另外，CMAC视频喉镜组的插管困难量表评分更低。
与米勒喉镜相比，CMAC视频喉镜可缩短插管时间并降低插管难度。因此，在为侧卧位婴儿进行气管插管时，CMAC视频喉镜可能是更有用的设备。
