Ambulkar Reshma, Ranganathan Priya, Savarkar Sukhada, Divatia Jigeeshu V
Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):477-482. doi: 10.4103/joacp.JOACP_1_20. Epub 2021 Jan 18.
The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries.
We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). The secondary objectives included success rates, number of attempts, need for optimization maneuvers, Cormack and Lehane (CL) grade, and percentage of difficult intubations.
The mean TTI in the VL group was 43 (±10.6) versus 75 (±38.0) s in the Macintosh group (99% CI: 12.5; -51.6 s; < 0.001). The overall intubation success rate was 100% in both groups. All 29 (100%) patients in the VL group were intubated in the first attempt versus 26 (86%) patients in the Macintosh group (99% CI -5; 33%; = 0.11). In the Macintosh group, 20 (66%) patients needed optimization maneuver versus none in the VL group (99% CI 40; 91%; < 0.001). In the VL group, 28 (96%) patients had a CL grade 1 view versus 9 (31%) in Macintosh group (99% CI 38; 92%; < 0.001). There were no difficult intubations in the VL group versus 3 (10%) in the Macintosh group (99% CI: 7; 28%; = 0.237). There was no trauma to oropharyngeal structures in either group.
The McGRATH series 5 VL has faster TTI, better glottic visualization, and less need for optimization maneuvers than the Macintosh laryngoscope for NTI in patients with unanticipated difficult airways, when performed by experienced anesthetists.
本研究旨在比较McGRATH 5系列视频喉镜（VL）与麦金托什喉镜在接受头颈癌手术且无预期困难气道的患者中行鼻气管插管（NTI）时的效果。
我们将60例成年患者随机分为两组，由经验丰富的麻醉医生分别使用麦金托什喉镜或McGRATH 5系列VL进行NTI（VL组）。主要目标是比较插管时间（TTI）。次要目标包括成功率、尝试次数、优化操作需求、科马克和莱哈尼（CL）分级以及困难插管的百分比。
VL组的平均TTI为43（±10.6）秒，而麦金托什组为75（±38.0）秒（99%可信区间：12.5；-51.6秒；<0.001）。两组的总体插管成功率均为100%。VL组的所有29例（100%）患者首次尝试即成功插管，而麦金托什组为26例（86%）患者（99%可信区间-5；33%；P = 0.11）。在麦金托什组中，20例（66%）患者需要优化操作，而VL组无一例需要（99%可信区间40；91%；<0.001）。在VL组中，28例（96%）患者的CL分级为1级视野，而麦金托什组为9例（31%）（99%可信区间38；92%；<0.001）。VL组无困难插管病例，而麦金托什组有3例（10%）（99%可信区间：7；28%；P = 0.237）。两组均未出现口咽结构损伤。
对于无预期困难气道的患者，由经验丰富的麻醉医生进行NTI时，McGRATH 5系列VL比麦金托什喉镜的TTI更快，声门可视化更好，且优化操作需求更少。
