From the Department of Anesthesia, John R. Oishei Children's Hospital, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.
Anesth Analg. 2020 Oct;131(4):1210-1216. doi: 10.1213/ANE.0000000000004802.
The use of a shoulder roll to view the glottic opening during direct laryngoscopy in infants has been recommended but is not evidence based.
Twenty infants with normal airways, <6 months of age undergoing elective surgery under general anesthesia were randomized to undergo direct laryngoscopy first with a 2-inch vertical shoulder roll and then without, or vice versa. The primary outcome was the difference in the vertical distance between the angle of the laryngoscopist's eye and the operating room table in the 2 positions. Also, the views of the glottic opening in both positions were recorded for each infant and analyzed by a blinded investigator using the percent of glottic opening (POGO).
Twenty infants completed the study without complications. The vertical distance did not differ significantly whether the shoulder roll was placed first or second, and there was no evidence of a differential carryover effect in the crossover design (P = .268). The main effect of the shoulder roll on the mean (95% confidence interval [CI]) vertical distances without 47.8 cm (43.5-52.1) and with the shoulder roll 37.2 cm (33.3-41) yielded a mean (95% CI) vertical difference of 10.6 cm (9.3-11.79; P = .0001). The median (interquartile range [IQR]) POGO scores without 100 [86.2, 100] and with the shoulder roll 97.5 [80, 100] did not differ (median difference [95% CI]: 0 [-20 to 0]; P = .39).
A 2-inch shoulder roll lowers the line of sight of the glottic opening compared with no shoulder roll, without affecting the view of the glottic opening during laryngoscopy in infants.
在婴儿行直接喉镜检查时，推荐使用肩部滚动来观察声门开口，但这并无证据支持。
20 名气道正常、<6 月龄、在全身麻醉下择期行手术的婴儿，随机分为 2 组，先在 2 英寸垂直肩部滚轴上进行直接喉镜检查，然后不使用肩部滚轴检查，或反之。主要结局为 2 种体位下，喉镜医师眼部与手术室台面之间的垂直距离差异。同时，记录了每个婴儿在 2 种体位下的声门开口视图，并由一名盲法研究者使用声门开口百分比（POGO）进行分析。
20 名婴儿顺利完成研究，无并发症发生。肩部滚轴先放或后放，其垂直距离无显著差异，交叉设计也无明显的交叉效应（P=.268）。无肩部滚轴时（均值[95%置信区间]：47.8cm[43.5-52.1]）与有肩部滚轴时（37.2cm[33.3-41]）的平均（95%CI）垂直距离差值为 10.6cm[9.3-11.79；P=.0001]。无肩部滚轴时的 POGO 评分中位数（四分位距[IQR]）为 100[86.2，100]，有肩部滚轴时为 97.5[80，100]，差异无统计学意义（中位数差值[95%CI]：0[-20 至 0]；P=.39）。
与无肩部滚轴相比，2 英寸肩部滚轴降低了声门开口的视线，但对婴儿喉镜检查时的声门开口观察无影响。
