Departments of Anesthesiology & Pain Management.
Neurological Surgery.
J Neurosurg Anesthesiol. 2020 Jan;32(1):57-62. doi: 10.1097/ANA.0000000000000560.
This study compared the Macintosh blade direct laryngoscope, Glidescope, C-Mac d-Blade, and McGrath MAC X-blade video laryngoscopes in 2 cadaveric models with severe cervical spinal instability. We hypothesized that the Glidescope video laryngoscope would allow for intubation with the least amount of cervical spine movement. Our secondary endpoints were glottic visualization and intubation success.
In total, 2 fresh cadavers underwent maximal surgical destabilization from the craniocervical junction to the cervicothoracic junction by a neurosurgical spine specialist, with subsequent neutral positioning of the heads with surgical head fixation devices. On each cadaver, 8 experienced anesthesiologists performed four intubations with the 4 laryngoscopes in random order. Lateral radiographic measurements determined vertebral displacement during intubation.
Cervical spine displacements were not significantly different amongst video laryngoscopes. Cormack-Lehane Grade 1 views were achieved with all attempts with each of the 3 video laryngoscopes; intubation attempts with the Macintosh blade achieved only grade 3 or grade 4 views. Intubation was successful every time with a video laryngoscope but only during 1 of 16 intubation attempts with the Macintosh blade.
In a cadaveric model with maximally destabilized cervical spines, cervical spine movement was observed during attempted laryngoscopy using each of 3 video laryngoscopes, although there was no significant difference between the laryngoscopes. Given cervical spine displacement occurred, these video laryngoscopes do not prevent cervical spine motion during laryngoscopy. However, with improved glottic visualization and intubation success, video laryngoscopes are superior to the Macintosh blade in both cervical spine safety and intubation efficacy in the model studied.
本研究在 2 具严重颈椎不稳定的尸体模型中比较了 Macintosh 叶片直接喉镜、Glidescope、C-Mac d-Blade 和 McGrath MAC X 叶片视频喉镜。我们假设 Glidescope 视频喉镜能够在颈椎活动最小的情况下进行插管。我们的次要终点是声门可视化和插管成功率。
总共 2 具新鲜尸体由神经外科脊柱专家进行最大限度的手术不稳定，从颅颈交界处到颈胸交界处，随后使用手术头固定装置将头部置于中立位置。在每具尸体上，8 名经验丰富的麻醉师使用 4 种喉镜以随机顺序进行 4 次插管。侧位 X 线片测量确定插管过程中椎体的位移。
视频喉镜之间的颈椎位移没有显著差异。3 种视频喉镜的所有尝试均获得 Cormack-Lehane 分级 1 视图；Macintosh 叶片的插管尝试仅获得 3 级或 4 级视图。每次使用视频喉镜都能成功插管，但 Macintosh 叶片仅在 16 次插管尝试中的 1 次成功。
在颈椎最大不稳定的尸体模型中，使用 3 种视频喉镜中的每一种进行喉镜检查时，均观察到颈椎运动，但喉镜之间无显著差异。鉴于发生了颈椎移位，这些视频喉镜在喉镜检查期间并不能防止颈椎运动。然而，在本研究模型中，视频喉镜在改善声门可视化和插管成功率方面优于 Macintosh 叶片，在颈椎安全性和插管效果方面均具有优势。
