From the Department of Anesthesiology, Critical Care and Pain Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem (AA, YS, AC, CW) and Intensive Care Unit, Shaarei Zedek Medical Center, Jerusalem, Israel (PDL).
Eur J Anaesthesiol. 2020 Jun;37(6):443-450. doi: 10.1097/EJA.0000000000001199.
Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management.
The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques.
Retrospective cohort study.
Tertiary care referral centre.
Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems.
Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P < 0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [before 149/8306 (1.8%); after 85/8517 (1.0%), P < 0.0001]. The GlideScope replaced flexible fibreoptic bronchoscopy in most cases with expected and unexpected difficult intubation. In patients with limited mouth opening, flexible fibreoptic bronchoscopy was still mostly the first choice after the introduction of the GlideScope. There was a 70% reduction in the use of other difficult intubation techniques after the introduction of the GlideScope [before 84/8306 (1.0%); after 22/8517 (0.3%), P < 0.0001)].
The GlideScope videolaryngoscope replaced flexible fibreoptic bronchoscopy for most patients with expected and unexpected difficult intubation. In the case of limited mouth opening, flexible fibreoptic bronchoscopy was still the first choice after the introduction of the GlideScope. The reduced use of flexible fibreoptic bronchoscopy raises concerns that residents may not be adequately trained in this essential airway management technique. GlideScope use was disproportionately greater than the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.
可视喉镜 GlideScope 的引入改变了困难气道管理中其他设备的使用方式。
研究可视喉镜 GlideScope 对纤维光导支气管镜引导下插管和其他困难气道管理技术的适应证变化和使用频率的影响。
回顾性队列研究。
三级转诊中心。
比较引入 GlideScope 前后两段长度相等（各 647 天）的时期。分析使用非直接喉镜技术插管的患者信息。数据从麻醉和医院信息管理系统中检索。
在引入 GlideScope 之前，8306 例患者中有 235 例（2.8%）和 8517 例患者中有 480 例（5.6%）需要困难气道管理技术（P<0.0001）。引入 GlideScope 后，纤维光导支气管镜的使用率总体下降了 44.4%[之前为 149/8306（1.8%）；之后为 85/8517（1.0%），P<0.0001]。GlideScope 取代了纤维光导支气管镜，用于大多数预期和意外困难插管的病例。在张口度有限的患者中，引入 GlideScope 后，纤维光导支气管镜仍然是首选。引入 GlideScope 后，其他困难插管技术的使用率下降了 70%[之前为 84/8306（1.0%）；之后为 22/8517（0.3%），P<0.0001]。
可视喉镜 GlideScope 取代了纤维光导支气管镜，用于大多数预期和意外困难插管的患者。在张口度有限的情况下，引入 GlideScope 后，纤维光导支气管镜仍然是首选。纤维光导支气管镜使用率的降低引起了人们的关注，即住院医师可能没有接受过这种基本气道管理技术的充分培训。GlideScope 的使用量与纤维光导支气管镜和其他困难插管技术的减少量不成比例。这可能归因于住院医师在对插管困难程度低至中度怀疑的患者中进行教学和使用。
