Dharmarajan Harish, Liu Yi-Chun Carol, Hippard Helena Karlberg, Chandy Binoy
Baylor College of Medicine, Department of Otolaryngology - Head and Neck Surgery, One Baylor Plaza Suite NA-102, Houston, TX 77030, USA.
Baylor College of Medicine, Department of Otolaryngology - Head and Neck Surgery, One Baylor Plaza Suite NA-102, Houston, TX 77030, USA; Texas Children's Hospital, Department of Pediatric Otolaryngology, 6701 Fannin St, Suite 540, Houston, TX 77030, USA.
Int J Pediatr Otorhinolaryngol. 2018 Feb;105:171-175. doi: 10.1016/j.ijporl.2017.12.023. Epub 2017 Dec 24.
Pediatric otolaryngologists are frequently called to assist in difficult airway management in newborns with Pierre Robin Sequence (PRS) who have microretrognathia, glossoptosis, and an anterior larynx. The Bonfils fiberscope (BF) is a curved rigid scope designed to provide superior visualization in the anterior larynx.
(1) to assess whether BF provides an improvement in intubation success rate, time to intubation, or airway visualization as compared to rigid fiberscope (RF) in a difficult airway simulation setting and (2) to determine whether a training program for BF can improve time to intubation through practice trials.
Six right-handed trainees completed five trials on each of the three following airway models using the BF and RF: normal anatomy, anterior larynx and PRS. The normal larynx model was intubated only with RF. Main outcome measures were the time needed for tracheal intubation and Cormack-Lehane classification (1-4).
The majority of the intubation trials showed a statistically significant difference between first and last completion times (p < .05) suggesting construct validity. Only the anterior larynx trials with BF did not demonstrate an improvement in time to intubation between first and last attempts (p < .3125). For the PRS retrognathia model, there was no statistically significant difference in time to intubation between using the BF and the RF (p < .44); in the anterior larynx model, the RF yielded a faster time to intubation than the BF on the final trial attempts (p < .0313). By Cormack-Lehane classification measures, laryngeal visualization by the BF was better than RF in the PRS manikin (p < .0022) while there was no significant difference in grade scores for the anterior larynx manikin (p < .45). All six trainees reported an improved visualization of the larynx with the BF compared to the RF for both the anterior larynx and PRS manikins; at the end of the trial runs, all participants noted an improvement in comfort level using the BF.
The difficult airway simulation model is feasible for surgical training. BF adds superior visualization of the anterior larynx in PRS. Otolaryngology training programs may include BF as a supplemental tool in addition to RF as a part of the airway equipment training since there is significant improvement in time to intubation with consecutive practice trials and superior laryngeal visualization.
小儿耳鼻喉科医生经常被要求协助处理患有Pierre Robin序列征（PRS）的新生儿的困难气道管理，这些新生儿存在小下颌后缩、舌后坠和喉前置。邦菲尔斯纤维喉镜（BF）是一种弯曲的硬镜，旨在为喉前置提供更好的视野。
（1）评估在困难气道模拟环境中，与硬式纤维喉镜（RF）相比，BF是否能提高插管成功率、缩短插管时间或改善气道视野；（2）确定BF培训计划是否能通过实践试验缩短插管时间。
六名右利手学员使用BF和RF在以下三种气道模型上各完成五次试验：正常解剖结构、喉前置和PRS。正常喉模型仅使用RF进行插管。主要观察指标为气管插管所需时间和Cormack-Lehane分级（1-4级）。
大多数插管试验显示首次和最后完成时间之间存在统计学显著差异（p < 0.05），表明结构效度。只有BF的喉前置试验在首次和最后一次尝试之间未显示插管时间有所改善（p < 0.3125）。对于PRS后缩下颌模型，使用BF和RF的插管时间在统计学上无显著差异（p < 0.44）；在喉前置模型中，最终试验尝试时RF的插管时间比BF更快（p < 0.0313）。根据Cormack-Lehane分级标准，在PRS人体模型中BF的喉部视野优于RF（p < 0.0022），而在喉前置人体模型中分级分数无显著差异（p < 0.45）。所有六名学员均报告，与RF相比，BF在喉前置和PRS人体模型中对喉部的视野均有所改善；在试验结束时，所有参与者都指出使用BF时舒适度有所提高。
困难气道模拟模型对于手术培训是可行的。BF在PRS中能提供更好的喉前置视野。耳鼻喉科培训计划可将BF作为气道设备培训的一部分，除RF外作为补充工具，因为连续的实践试验能显著缩短插管时间且喉部视野更佳。
