Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Neurosurg Anesthesiol. 2022 Jan 1;34(1):57-63. doi: 10.1097/ANA.0000000000000717.
McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery.
Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts.
In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation.
Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.
在对行颈椎内固定术的颈椎损伤患者进行插管时，采用 McGrath MAC 可视喉镜进行手动直线稳定可有助于成功插管。本研究旨在确定颈椎手术患者行 McGrath MAC 可视喉镜插管困难的影像学预测指标。
本研究纳入了 2016 年 6 月至 2018 年 8 月期间在接受颈椎手术且采用 McGrath MAC 可视喉镜在手动直线固定颈椎的情况下进行插管的患者。回顾性收集了气道相关变量和术前颈椎侧位 X 线片、磁共振成像（MRI）和计算机断层扫描（CT）扫描获得的影像学指标数据。根据插管时间和插管尝试次数，将患者分为 McGrath MAC 可视喉镜插管困难组和插管容易组。
共纳入 183 例患者，其中 33 例（18%）出现可视喉镜插管困难。多变量 logistic 回归分析显示，颈椎侧位 X 线片上的寰枕距离（比值比 [OR]，0.74；95%置信区间 [CI]，0.62-0.89；P=0.001）、颈椎侧位 X 线片上颈椎伸展位切牙-C1-C6 角（OR，1.12；95% CI，1.02-1.22；P=0.015）、颈椎 MRI 或 CT 矢状中平面的舌体/口腔面积比（OR，1.12；95% CI，1.05-1.19；P<0.001）和切牙间隙（OR，0.92；95% CI，0.86-0.98；P=0.015）是 McGrath MAC 可视喉镜插管困难的独立危险因素。
提示舌体相对口腔增大且颈椎伸展受限的影像学指标与颈椎内固定术患者插管时手动直线颈椎稳定下 McGrath MAC 可视喉镜插管困难相关。
