Bak Ji Won, Noh Yeonji, Kim Juyoun, Hwang Byeongmun, Kang Seongsik, Son Heejeong, Kim Minsoo
Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
Department of Anesthesiology and Pain Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea.
Anesth Pain Med (Seoul). 2022 Jan;17(1):104-111. doi: 10.17085/apm.21095. Epub 2021 Dec 30.
The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations.
Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded.
There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different.
In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.
GlideScope®视频喉镜（GVL）广泛应用于气道困难的患者，能提供良好的声门视野。然而，喉镜叶片的锐角会使气管内插管（ETT）的插入和推进比直接喉镜检查更困难，因此建议使用管芯。本随机对照试验比较了Parker Flex-It™管芯（PFS）和GlideRite®硬质管芯（GRS）在模拟困难插管中辅助GVL插管的效果。
54例患者被随机分配，分别使用GRS（GRS组）或PFS（PFS组）进行GVL插管。记录总插管时间（TIT）、插管难易程度的100毫米视觉模拟量表（VAS）评分、首次尝试成功率、喉操作的使用情况、助手推进导管的速率以及并发症。
GRS组和PFS组的TIT无显著差异（GRS组为50.3±12.0秒，PFS组为57.8±18.8秒，P = 0.108）。然而，根据VAS评分，PFS组的插管比GRS组更困难（P = 0.011）。助手将ETT从管芯推进的情况在GRS组比PFS组更频繁（P = 0.002）。可能并发症的总体发生率无显著差异。
在模拟气道困难的患者中，使用PFS或GRS的TIT没有差异。然而，使用PFS进行气管插管比GRS更困难。
