Chandy Jacob, Pillai Rahul, Mathew Amit, Philip Amitav V, George Sajan P, Sahajanandan Raj
Department of Anesthesia, CMC, Vellore, Tamil Nadu, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):604-609. doi: 10.4103/joacp.JOACP_75_20. Epub 2022 Jan 6.
Cervical spine immobilization renders direct laryngoscopy difficult. The CMAC D blade and the channeled blade of the King Vision videolaryngoscopes, have both been used for difficult airway management. Our hypothesis is that the channeled blade of the King Vision would be superior to the CMAC D blade in terms of ease of intubation. We tested this hypothesis in a randomized comparison of the two videolaryngoscopes in patients with simulated cervical spine immobilization.
Hundred patients with no anticipated airway difficulty were randomly allocated to two groups after obtaining informed written consent. Following induction, manual inline stabilization (MILS) was applied to simulate a cervical spine injury and immobilzation. Patients were intubated with either of the two videolaryngoscopes. Time for visualization of the glottis, procedural time, intubation difficulty scale (IDS), and hemodynamic response were recorded.
The time to visualize the glottis was shorter in the CMAC D group as compared to the King Vision group ( < 0.001). The incidence of external laryngeal manipulation was less in the King Vision group ( < 0.001). The ease of intubation was superior in the King Vision group, based on the IDS ( < 0.001). The haemodynamic response was similar between the groups.
King Vision channeled videolaryngoscope was difficult to introduce into the mouth of the patient during laryngoscopy. Once introduced into the mouth, the time for intubation was less and less external laryngeal manipulation maneuvers were performed to achieve successful intubation. The ease of endotracheal intubation was superior for the King Vision videolaryngoscope. The King Vision videolaryngoscope with proper tranining, could be a safe and portable alternative in patients with cervical spine immobilization.
颈椎固定会使直接喉镜检查变得困难。CMAC D型镜片和King Vision视频喉镜的带通道镜片都已用于困难气道管理。我们的假设是，就插管的难易程度而言，King Vision的带通道镜片优于CMAC D型镜片。我们在模拟颈椎固定的患者中对这两种视频喉镜进行随机比较，以验证这一假设。
在获得患者书面知情同意后，将100例无预期气道困难的患者随机分为两组。诱导后，采用手动轴向稳定（MILS）来模拟颈椎损伤和固定。使用两种视频喉镜中的一种对患者进行插管。记录声门可视化时间、操作时间、插管困难量表（IDS）和血流动力学反应。
与King Vision组相比，CMAC D组的声门可视化时间更短（<0.001）。King Vision组的外部喉操作发生率更低（<0.001）。根据IDS，King Vision组的插管难易程度更高（<0.001）。两组之间的血流动力学反应相似。
在喉镜检查期间，King Vision带通道视频喉镜很难插入患者口腔。一旦插入口腔，插管时间更短，且为成功插管所进行的外部喉操作更少。King Vision视频喉镜的气管插管难易程度更高。经过适当培训，King Vision视频喉镜对于颈椎固定的患者可能是一种安全且便于携带的替代方案。
