Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
PLoS One. 2020 Aug 13;15(8):e0237593. doi: 10.1371/journal.pone.0237593. eCollection 2020.
Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized crossover study, we compared the effectiveness of the MVS Stylet Scope to a standard direct laryngoscope with Miller #1 blade in simulated normal and difficult airways.
Fifteen expert anesthesiologists and Fifteen anesthesiology residents participated in the study. Participants were asked to perform intubation with the Airsim Baby manikin first, and then with the Airsim Pierre Robin manikin. Participants in each group used the intubation devices in a randomized order. The primary outcome was the time of successful intubation. The secondary outcomes were the force exerted on the incisors during intubation, Cormack-Lehane scale, the difficulty of intubation.
There were no differences between MVS Stylet Scope and Direct laryngoscope in the time of successful intubation by the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved the force exerted on the incisors during intubation in the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved Cormack-Lehane scale, and the difficulty of intubation with difficult pediatric airway situation in both expert anesthesiologists and anesthesiology residents.
Although less forces on the incisors and improved view of glottis were observed with the MVS Stylet Scope, MVS Stylet Scope did not shorten the time of intubation. The results of this study mean that the MVS Stylet Scope may be a less invasive airway devise than the direct laryngoscope with the Miller blade in the pediatric airway management. For the next step, we need to evaluate the MVS Stylet Scope in the real patients as an observational study.
处理困难的小儿气道具有挑战性。MultiViewScope（MVS）管芯喉镜据称在困难的小儿气道中有用。在这项随机交叉研究中，我们比较了 MVS 管芯喉镜与标准的带有 Miller #1 刀片的直接喉镜在模拟正常和困难气道中的有效性。
15 名麻醉专家和 15 名麻醉住院医师参加了这项研究。要求参与者首先使用 Airsim Baby 人体模型进行插管，然后使用 Airsim Pierre Robin 人体模型进行插管。每组参与者以随机顺序使用插管设备。主要结果是成功插管的时间。次要结果是插管过程中施加在切牙上的力、Cormack-Lehane 分级、插管难度。
在正常或困难的小儿气道中，MVS 管芯喉镜与直接喉镜在专家麻醉师或麻醉住院医师的成功插管时间方面没有差异。MVS 管芯喉镜在正常或困难的小儿气道中显著降低了专家麻醉师或麻醉住院医师插管时施加在切牙上的力。MVS 管芯喉镜显著改善了 Cormack-Lehane 分级和困难的小儿气道情况下的插管难度。
尽管在使用 MVS 管芯喉镜时观察到施加在切牙上的力较小，并且喉镜下声门的可视性得到改善，但 MVS 管芯喉镜并没有缩短插管时间。这项研究的结果意味着在小儿气道管理中，MVS 管芯喉镜可能比带有 Miller 刀片的直接喉镜具有更小的侵袭性。下一步，我们需要作为观察性研究在真实患者中评估 MVS 管芯喉镜。
