Venketeswaran Meenakshi V, Srinivasaraghavan Nivedhyaa, Balakrishnan Kalpana, Seshadri Ramakrishnan A, Sriman Sahithya
Department of Anaesthesia, Pain and Palliative Care, Chennai, Tamil Nadu, India.
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
Indian J Anaesth. 2021 Mar;65(3):221-228. doi: 10.4103/ija.IJA_1578_20. Epub 2021 Mar 13.
The aerosol box (AB), an improvised device used during the coronavirus disease (COVID)-19 pandemic, has attracted both interest and controversy. Several simulated studies have examined its protective efficacy as well as intubation efficiency. The aim of this study was to evaluate the practical conduct of intubation using the AB in patients undergoing elective, oncological surgery during the pandemic.
This prospective, observational study included adult patients undergoing oncological surgery. Thirteen anaesthesiologists performed 132 intubations using one of three ABs designated as AB 1, AB 2 and AB 3. The primary outcome was the difference in the time to intubation (TTI) between patients with Mallampati score MP I-II (Group 1) and MP III-IV (Group 2). Secondary outcomes included first-pass success rate, fall in peripheral oxygen saturation to < 95%, total number of attempts and failure to intubate using the AB.
The mean TTI was not significantly different in Group 1 and Group 2 (71.02 (61.66) s vs. 101.35 (121.94) s respectively, = 0.119). Desaturation during intubation was seen in 20 patients (15.1%). First pass success rate was achieved in 109 patients (82.6%). Twenty-one patients (15.9%) needed more than one attempt to intubate and the box had to be removed in 8 patients (6.1%) for facilitating intubation. The Mallampati score did not significantly influence either desaturation or first pass success rate.
There was a non-significant increasing TTI trend in patients with a higher MP score with the use of an aerosol box. However, this did not translate to a clinically significant difference in the overall intubation outcomes.
气溶胶箱（AB）是在冠状病毒病（COVID）-19大流行期间使用的一种简易装置，引起了人们的关注和争议。多项模拟研究考察了其保护效果以及插管效率。本研究的目的是评估在大流行期间对接受择期肿瘤手术的患者使用AB进行插管的实际操作情况。
这项前瞻性观察性研究纳入了接受肿瘤手术的成年患者。13名麻醉医生使用指定为AB 1、AB 2和AB 3的三种AB之一进行了132次插管。主要结局是Mallampati评分MP I-II（第1组）和MP III-IV（第2组）患者之间插管时间（TTI）的差异。次要结局包括首次通过成功率、外周血氧饱和度降至<95%、总尝试次数以及使用AB插管失败情况。
第1组和第2组的平均TTI无显著差异（分别为71.02（61.66）秒和101.35（121.94）秒，P = 0.119）。20名患者（15.1%）在插管过程中出现了血氧饱和度下降。109名患者（82.6%）实现了首次通过成功。21名患者（15.9%）需要多次尝试插管，8名患者（6.1%）为便于插管不得不移除气溶胶箱。Mallampati评分对血氧饱和度下降或首次通过成功率均无显著影响。
使用气溶胶箱时，MP评分较高的患者TTI有非显著的增加趋势。然而，这并未转化为总体插管结局的临床显著差异。
