Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
BMC Anesthesiol. 2020 Feb 26;20(1):47. doi: 10.1186/s12871-020-00966-3.
The Optiscope™ can be used for intubation with minimal neck motion. We retrospectively investigated radiographic predictors of difficult intubation using the Optiscope™ by analyzing preoperative radiographic images.
One hundred eighty-four patients who were intubated with the Optiscope™ under manual in-line cervical stabilization for cervical spine surgery were enrolled. Radiographic indices were measured on preoperative cervical spine lateral X-ray and magnetic resonance imaging images. Difficult intubation was defined as failure or time consumption more than 90 s on the first attempt. To identify significant predictors of difficult intubation using the Optiscope™ and evaluate their diagnostic value, multivariable logistic regression and receiver operating characteristic analyses were used.
Fourty-seven patients showed difficult intubation. There was no significant difference in radiographic indices between the difficult and easy intubation groups, but higher body mass index (BMI) (26.5 [3.0] vs. 24.6 [3.5] kg/m, P = 0.001), shorter sternomental distance (SMD) (122.0 [104.0 to 150.0] vs. 150.0 [130.0 to 170.0] mm, P = 0.001), shorter interincisor gap (40.0 [35.0 to 45.0] vs. 43.0 [40.0 to 50.0] mm, P = 0.006), and higher incidence of excessive oral secretions (10.6% vs. 2.9%, P = 0.049) were observed in patients with difficult intubation. In multivariable analysis, BMI (odds ratio [95% confidence interval]; 1.15 [1.03 to 1.28], P = 0.011) and SMD (odds ratio [95% confidence interval]; 0.98 [0.97 to 1.00], P = 0.008) were associated with difficult intubation with the Optiscope™. In receiver operating characterstic analysis, the area under the curve for body mass index was 0.68 (95% confidence interval; 0.60 to 0.77, P < 0.001) and that for sternomental distance was 0.66 (95% confience interval; 0.57 to 0.75, P = 0.001).
The incidence of difficult intubation using the Optiscope™ under manual in-line cervical stabilization was 25.5% in cervical spine surgery patients. No significant predictor of difficult intubation with the Optiscope™ was identified among the measured radiographic indices. Although high BMI and short SMD were predictive of difficult intubation with the Optiscope™, their discrimination power was weak.
Optiscope™ 可用于在最小颈部运动下进行插管。我们通过分析术前颈椎侧位 X 线和磁共振成像图像，回顾性研究了使用 Optiscope™ 进行插管的困难预测因素。
184 例颈椎手术中使用 Optiscope™ 在手动直线颈椎稳定下进行插管的患者入组。在术前颈椎侧位 X 线片和磁共振成像图像上测量影像学指标。将困难插管定义为首次尝试失败或耗时超过 90s。为了确定使用 Optiscope™ 进行困难插管的显著预测因素并评估其诊断价值，使用多变量逻辑回归和接收者操作特征分析。
47 例患者插管困难。困难插管组和容易插管组的影像学指标无显著差异，但 BMI（26.5[3.0] vs. 24.6[3.5]kg/m，P=0.001）较高，短颈（SMD）（122.0[104.0-150.0] vs. 150.0[130.0-170.0]mm，P=0.001），短切牙间隙（40.0[35.0-45.0] vs. 43.0[40.0-50.0]mm，P=0.006）和较高的口腔分泌物过多发生率（10.6% vs. 2.9%，P=0.049）。多变量分析中，BMI（比值比[95%置信区间]；1.15[1.03-1.28]，P=0.011）和 SMD（比值比[95%置信区间]；0.98[0.97-1.00]，P=0.008）与 Optiscope™插管困难相关。受试者工作特征分析中，BMI 的曲线下面积为 0.68（95%置信区间；0.60-0.77，P<0.001），SMD 的曲线下面积为 0.66（95%置信区间；0.57-0.75，P=0.001）。
颈椎手术患者在手动直线颈椎稳定下使用 Optiscope™ 插管的困难发生率为 25.5%。在测量的影像学指标中，未发现 Optiscope™ 插管困难的显著预测因素。尽管高 BMI 和短 SMD 可预测 Optiscope™ 插管困难，但它们的判别能力较弱。
