Department of Anesthesiology, Affiliated Hospital of Zunyi Medical College, No. 149 Dalian Road, Zunyi, 563000, China.
BMC Anesthesiol. 2019 May 15;19(1):75. doi: 10.1186/s12871-019-0737-3.
The video laryngoscope is recommended for intubating difficult airways. The present study aimed to determine whether the video laryngoscope can further improve intubation success rates compared with the direct laryngoscope in patients with non-difficult airways.
In total, 360 patients scheduled for elective abdominal surgeries were randomly assigned to undergo intubation using either a video laryngoscope (n = 179) or a direct laryngoscope (n = 181). The following parameters were measured: mouth opening; thyromental distance; sternomental distance; shape angle of the tracheal catheter; and glottic exposure grade.
The percentage of patients with level I-II of total glottic exposure in the video laryngoscope group was 100% versus 63.5% in the direct laryngoscope group (P < 0.001). The one-attempt success rate of intubation was 96.1% using a video laryngoscope versus 90.1% using a direct laryngoscope (P = 0.024). The intubation success rate using a video laryngoscope was 100% versus 94.5% using a direct laryngoscope (P = 0.004). Immediate oropharyngeal injury occurred in 5.1% of patients intubated using a direct laryngoscope versus 1.1% using a video laryngoscope (P = 0.033). On postoperative day 1, obvious hoarseness was exhibited by 7.9% of patients intubated using a direct laryngoscope versus 2.8% using a video laryngoscope (P = 0.035). The grade of glottic exposure and catheter shape angle were independent risk factors for tracheal intubation failure. Thyromental distance, shape angle, glottic exposure time, and surgical position were independent risk factors for postoperative complications. Thyromental distance and glottic exposure time were independent risk factors for complications lasting > 2 days.
Intubation using a video laryngoscope yielded significantly higher intubation success rates and significantly fewer postoperative complications than direct laryngoscopy in patients with non-difficult airways.
Chinese Clinical Trial Registry. No: ChiCTR-IOR-16009023 . Prospective registration.
视频喉镜推荐用于困难气道插管。本研究旨在确定在非困难气道患者中，与直接喉镜相比，视频喉镜是否能进一步提高插管成功率。
总共 360 名择期行腹部手术的患者被随机分为视频喉镜组（n=179）或直接喉镜组（n=181）进行插管。测量以下参数：张口度；甲状软骨-下颌骨距离；胸骨-下颌骨距离；气管导管形状角；声门暴露分级。
视频喉镜组总声门暴露Ⅰ-Ⅱ级的患者比例为 100%，而直接喉镜组为 63.5%（P<0.001）。视频喉镜组一次插管成功率为 96.1%，直接喉镜组为 90.1%（P=0.024）。视频喉镜组插管成功率为 100%，直接喉镜组为 94.5%（P=0.004）。直接喉镜组有 5.1%的患者发生即刻或口咽损伤，而视频喉镜组为 1.1%（P=0.033）。术后第 1 天，直接喉镜组有 7.9%的患者出现明显声音嘶哑，而视频喉镜组为 2.8%（P=0.035）。声门暴露分级和导管形状角是气管插管失败的独立危险因素。甲状软骨-下颌骨距离、导管形状角、声门暴露时间和手术体位是术后并发症的独立危险因素。甲状软骨-下颌骨距离和声门暴露时间是并发症持续>2 天的独立危险因素。
在非困难气道患者中，与直接喉镜相比，视频喉镜插管成功率显著提高，术后并发症显著减少。
中国临床试验注册中心。编号：ChiCTR-IOR-16009023。前瞻性注册。
