Ray Ananya, Sen Indu Mohini, Bhardwaj Neerja, Yaddanapudi Sandhya, Mathews Preethy
Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Anaesth. 2021 Aug;65(8):593-599. doi: 10.4103/ija.ija_463_21. Epub 2021 Aug 25.
In the cleft lip and palate, the laryngoscope blade often tends to lodge inside midline clefts, causing reduced manoeuvrability and tissue trauma. The paraglossal technique avoids the midline and offers better Cormack Lehane (CL) grades. We aimed to assess the first-pass intubation rate in performing the left paraglossal laryngoscopy with a curved-blade videolaryngoscope (VLS) versus direct laryngoscope (DLS) in children with cleft palate and evaluate the time taken for successful endotracheal intubation (TTI) and Intubation Difficulty Score (IDS) with both devices.
This randomised controlled trial included 60 patients with cleft palate, between 3 months and 6 years. Patients were randomised into group V (VLS) (n = 30) and group D (DLS) (n = 30). Left paraglossal laryngoscopy was done with VLS or DLS, and the first-pass intubation, TTI, CL grade and IDS were recorded.
First-pass intubation (primary outcome) was successful in all cases in group V and in 29 (96%) cases in group D ( = 0.923). Amongst the secondary outcomes, the IDS of the majority in both groups was 1-4 (slight difficulty) ( = 0.98) and the mean TTI In group D was 34.6 s (SD = 19.0) (95% CI: 27.5-41.7) versus 39.8 s (SD = 5.2) (95% CI: 37.8-41.7) in group V ( = 0.151).
There was no significant difference in the use of a VLS over a DLS in performing the left paraglossal laryngoscopy in terms of first-pass intubation rate, CL Grade, IDS and TTI. Further studies with different VLS may be done to improve the ease of this technique.
在唇腭裂患者中，喉镜镜片常常容易卡在中线裂隙内，导致可操作性降低和组织创伤。舌旁入路技术可避开中线，能提供更好的科马克-莱汉内（CL）分级。我们旨在评估在腭裂患儿中使用弯叶片视频喉镜（VLS）与直接喉镜（DLS）进行左侧舌旁入路喉镜检查时的首次插管成功率，并评估两种设备成功气管插管所需时间（TTI）和插管难度评分（IDS）。
这项随机对照试验纳入了60例年龄在3个月至6岁之间的腭裂患者。患者被随机分为V组（VLS）（n = 30）和D组（DLS）（n = 30）。使用VLS或DLS进行左侧舌旁入路喉镜检查，并记录首次插管情况、TTI、CL分级和IDS。
V组所有病例首次插管（主要结局）均成功，D组29例（96%）成功（P = 0.923）。在次要结局中，两组大多数患者的IDS为1 - 4级（轻度困难）（P = 0.98），D组平均TTI为34.6秒（标准差 = 19.0）（95%置信区间：27.5 - 41.7），而V组为39.8秒（标准差 = 5.2）（95%置信区间：37.8 - 41.7）（P = 0.151）。
在进行左侧舌旁入路喉镜检查时，就首次插管成功率、CL分级、IDS和TTI而言，使用VLS与DLS并无显著差异。可开展不同VLS的进一步研究以提高该技术的简便性。
