Ho Chia-Hao, Chen Li-Chung, Hsu Wen-Hao, Lin Tzu-Yu, Lee Meng, Lu Cheng-Wei
Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan.
Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan.
J Clin Med. 2022 Apr 29;11(9):2499. doi: 10.3390/jcm11092499.
In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack-Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used.
An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included.
Five articles met the inclusion criteria and were included in the final analysis ( = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack-Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used.
Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.
本研究表明，常规使用麦格拉斯视频喉镜可能会提高插管成功率。在鼻气管插管中使用视频喉镜的益处也得到了证实。然而，此前尚无关于麦格拉斯视频喉镜在鼻气管插管中有效性的确凿证据。因此，我们质疑，在接受口腔颌面部手术并行鼻气管插管的成年患者（P）中，与麦金托什喉镜（C）相比，使用麦格拉斯视频喉镜（I）是否能缩短插管时间，将声门可视化程度提高到科马克-莱汉内分级系统中的1级，并提高首次尝试成功率（O）。所测量的次要结局为使用麦吉尔钳的比率以及使用外部喉压迫（BURP）手法的情况。
使用数据库进行广泛的文献检索。仅纳入比较麦格拉斯视频喉镜和麦金托什喉镜技术在成年患者鼻气管插管中的随机对照试验。
五篇文章符合纳入标准并纳入最终分析（n = 331例患者）。结果显示，插管时间显著缩短，科马克-莱汉内分级系统中的1级评分率更高，但麦格拉斯组和麦金托什组之间的首次尝试成功率没有差异。汇总分析中还发现麦吉尔钳的使用比率和外部喉压迫手法的使用有所减少。关于总体偏倚风险，所选试验被分类为至少有中度偏倚风险，因为没有一项试验能够使操作者对所使用的喉镜类型保持盲态。
我们的分析表明，在接受牙科、口腔、颌面部或头颈癌手术全身麻醉的成年患者中，在鼻气管插管中使用麦格拉斯视频喉镜可缩短插管时间，改善声门视野，首次成功率相似，还减少了麦吉尔钳和BURP手法的使用。
