Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Sci Rep. 2019 Feb 4;9(1):1174. doi: 10.1038/s41598-018-37770-6.
Pediatric patients have large heads and relatively small bodies, making it difficult to perform intubation even in the sniffing position. Therefore, this study was planned on the assumption that hand-assisted elevation and caudad traction of the shoulder (HA-ECTS) would compensate for the laryngoscopic view. In this observational study, 45 pediatric patients aged 0-36 months with an ASA physical status of I-III and scheduled for elective surgery under general anesthesia were enrolled. HA-ECTS was defined as hand-assisted personalized traction in the upper and caudad directions with both hands under the lower cervical area. The POGO (percentage of glottis opening) score, MO (mouth opening), and LHS (laryngoscopic handling score) were compared before and after HA-ECTS. The median [range] POGO score was 30[10-50]% and 60[15-80]% before and after HA-ECTS, respectively (median difference, 20; 95% confidence interval [CI] 10 to 25%; P = 0.002). MO was 1.0[0.8-1.9] cm and 1.8[1.3-2.0] cm before and after HA-ECTS, respectively (median difference, 0.45 cm; 95% CI 0.25 to 0.60; P < 0.001). The ease of laryngoscopic handling was improved after HA-ECTS(P < 0.001). The application of HA-ECTS to pediatric patients younger than 3 years improved POGO score, MO, and LHS and could prove to be an assistive technique for tracheal intubation.
小儿患者头部较大，身体相对较小，即使在嗅探位也难以进行插管。因此，本研究假设手辅助提升和向尾侧牵引肩部（HA-ECTS）将补偿喉镜视野。在这项观察性研究中，纳入了 45 名年龄在 0-36 个月、ASA 身体状况为 I-III 级、计划在全身麻醉下接受择期手术的小儿患者。HA-ECTS 被定义为双手在颈下部辅助向上和向尾侧方向的个性化牵引。比较 HA-ECTS 前后的 POGO（声门张开百分比）评分、MO（口张开）和 LHS（喉镜操作评分）。POGO 评分的中位数[范围]分别为 HA-ECTS 前后的 30[10-50]%和 60[15-80]%（中位数差异，20；95%置信区间[CI] 10 至 25%；P = 0.002）。MO 分别为 1.0[0.8-1.9]cm 和 1.8[1.3-2.0]cm（中位数差异，0.45cm；95%CI 0.25 至 0.60；P < 0.001）。HA-ECTS 后喉镜操作的难易度得到改善（P < 0.001）。HA-ECTS 应用于 3 岁以下的小儿患者可改善 POGO 评分、MO 和 LHS，并可作为气管插管的辅助技术。
