Pachisia Anant V, Sharma Kavita R, Dali Jaspal S, Arya Mona, Pangasa Neha, Kumar Rakesh
Department of Critical Care Medicine, Asian Institute of Medical Sciences, Faridabad, Haryana, India.
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2019 Jul-Sep;35(3):312-317. doi: 10.4103/joacp.JOACP_35_19.
We compared the laryngoscopy position attained by a 7-cm-high pillow (Sniffing position-SP) with that attained by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using variable height inflatable pillow.
This prospective-randomised-cross-over study included 50 patients in each group. Group-AM-S: A 7 cm uncompressible pillow was used for attaining first laryngoscopy position, followed by horizontal alignment of external auditory meatus-sternal notch (AM-S) line-using an inflatable pillow for attaining second laryngoscopy position followed by intubation. Group-SP: Horizontal alignment of external auditory meatus-sternal notch (AM-S) line-was done using an inflatable pillow for attaining first laryngoscopy position, followed by using 7 cm uncompressible pillow for second laryngoscopy position followed by intubation. The CL-grade, Intubation Difficulty Score (IDS) and time to intubation were compared in both positions. The head raise (in cm) required for attaining AM-S alignment was noted.
CL-grade-I was obtained in significantly larger number of patients with AM-S alignment position than with 7 cm head raise ( = 0.004). CL-grade-III was obtained in significantly lesser number of patients with AM-S alignment ( = 0.002). Mean IDS with AM-S alignment (1.18 ± 1.69) was significantly less than with 7cm head raise (2 ± 1.59; = 0.007) and time to intubation with AM-S alignment (17.33 ± 4.52 s) was significantly less than that with 7cm head raise (18.94 ± 4.64 s; = 0.041). The mean head rise required to achieve AM-S line alignment was 4.920 ± 1.460 cm.
External Auditory Meatus-Sternal notch (AM-S) line alignment provides better laryngeal view, better intubating conditions and requires lesser time to intubate as compared to a conventional 7-cm-head raise. The size of pillow used for head raise should be individualised.
我们比较了使用7厘米高的枕头（嗅物位-SP）和使用可充气可变高度枕头使外耳道-胸骨切迹（AM-S）线水平对齐所达到的喉镜检查位置。
这项前瞻性随机交叉研究每组纳入50例患者。AM-S组：使用一个7厘米不可压缩的枕头获得第一个喉镜检查位置，然后使用可充气枕头使外耳道-胸骨切迹（AM-S）线水平对齐以获得第二个喉镜检查位置，随后进行插管。SP组：使用可充气枕头使外耳道-胸骨切迹（AM-S）线水平对齐以获得第一个喉镜检查位置，然后使用7厘米不可压缩的枕头获得第二个喉镜检查位置，随后进行插管。比较两个位置的CL分级、插管难度评分（IDS）和插管时间。记录实现AM-S对齐所需抬高头部的高度（厘米）。
与抬高7厘米头部相比，AM-S对齐位置获得CL-I级的患者数量显著更多（P = 0.004）。AM-S对齐获得CL-III级的患者数量显著更少（P = 0.002）。AM-S对齐时的平均IDS（1.18±1.69）显著低于抬高7厘米头部时（2±1.59；P = 0.007），且AM-S对齐时的插管时间（17.33±4.52秒）显著少于抬高7厘米头部时（18.94±4.64秒；P = 0.041）。实现AM-S线对齐所需的平均头部抬高为4.920±1.460厘米。
与传统的抬高7厘米头部相比，外耳道-胸骨切迹（AM-S）线对齐可提供更好的喉镜视野、更好的插管条件，且插管时间更短。用于抬高头部的枕头尺寸应个体化。
