Gupta Roopali, Sahni Ameeta
Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Saudi J Anaesth. 2020 Apr-Jun;14(2):206-211. doi: 10.4103/sja.SJA_808_19. Epub 2020 Mar 5.
Postburn contracture (PBC) of the neck is commonly seen after acute burn in the face and neck region. Managing the airway is a challenge due to functional and anatomical deformities. We compared the ease of intubation using video and direct laryngoscopes.
Eighty patients, 18-60 years of age with ASA physical status I/II with Onah's types 1 and 2 contracture of the neck were randomized in this study. Group DL were intubated by direct laryngoscopy (DL) using Macintosh blade and Group VL by video laryngoscopy (VL) using King Vision. The outcome measures were ease of intubation (EOI), Cormack-Lehane (CL) grading, and associated complications if any.
EOI score was significantly lower in group VL (0.42 ± 0.84) as compared to group DL (0.85 ± 1.21) ( = 0.048) as was the use of external maneuvers (group VL: 17.5%; group DL: 42.5%; = 0.015), and the use of stylet (group VL: 0%; group DL: 20%, = 0.005). CL grading improved significantly in group VL ( < 0.001). Occurrence of complications was negligible in both the groups. A single failure in group DL needed rescue intubation.
Intubation with a video laryngoscope was easier than with DL in patients with mild-to-moderate contracture neck with mouth opening >3 cm and MPG I/II.
面颈部急性烧伤后常见颈部烧伤后挛缩（PBC）。由于功能和解剖畸形，气道管理具有挑战性。我们比较了使用视频喉镜和直接喉镜进行插管的难易程度。
本研究将80例年龄在18 - 60岁、ASA身体状况为I/II级、颈部为奥纳1型和2型挛缩的患者随机分组。DL组使用麦金托什喉镜通过直接喉镜检查（DL）进行插管，VL组使用King Vision视频喉镜通过视频喉镜检查（VL）进行插管。观察指标为插管难易程度（EOI）、科马克 - 莱汉内（CL）分级以及相关并发症（如有）。
与DL组（0.85±1.21）相比，VL组的EOI评分显著更低（0.42±0.84）（P = 0.048），外部操作的使用情况也是如此（VL组：17.5%；DL组：42.5%；P = 0.015），以及探条的使用情况（VL组：0%；DL组：20%，P = 0.005）。VL组的CL分级显著改善（P < 0.001）。两组并发症的发生率均可忽略不计。DL组有1例插管失败需要进行挽救性插管。
对于口张开>3 cm且MPG I/II级的轻至中度挛缩颈部患者，使用视频喉镜插管比直接喉镜更容易。
