Department of Anesthesiology, Ankara University School of Medicine, Ankara, Turkey.
Eur Rev Med Pharmacol Sci. 2022 Aug;26(16):5763-5773. doi: 10.26355/eurrev_202208_29513.
Cases of obesity are rising in parallel with the number of obese patients scheduled for anesthesia in which difficult airway is encountered. Video laryngoscopes (VL) have emerged as a popular device for the management of patients with difficult airway. The present study compares the success rate of intubation in obese patients using stylet in the ramped position using either a McGrath or C-MAC VLs.
Class II/III obese patients who were intubated with either McGrath (Group M, n=50) or C-MAC (Group C, n=50) laryngoscopes were assessed for the presence of difficult airway using the Difficult Airway Assessment tool, the Airway Difficulty Score and the Total Airway Score. The intubation attempts were made after the best glottic view, direct and indirect Cormack-Lehane (CL) score, and intubation time were recorded. In the event of failure, a further intubation attempt was made using a styled, and the intubation time was again recorded. If the intubation failed again, a third attempt was made using a C-MAC D-Blade. The Intubation Difficulty Scale score was recorded after the intubation.
There was no statistically significant difference between groups in terms of demographic data, the number of patients with decreased CL score, the number of attempts required for intubation, or the first and second intubation time. The ADS Score, TAS Score, CL Score DL, and CL Score IN were found to be important risk factors for a second intubation requirement, and the cut-off value was found to be 8.50 for the ADS Score and 4.50 for the TAS Score in these patients. In the 38 patients who required a second intubation attempt, the procedure was successful in all, but one patient required a third attempt of intubation with C-MAC D-blade.
Both McGrath and C-MAC were effective and comparable for best glottic view with no failed intubation. It was concluded that regardless of the type of video laryngoscope used, the use of a stylet in the first intubation attempt increases the success of intubation.
肥胖病例与接受麻醉的肥胖患者数量呈平行上升趋势，而肥胖患者常存在困难气道。可视喉镜（VL）已成为处理困难气道患者的常用设备。本研究比较了在斜坡位使用管芯时，使用 McGrath 或 C-MAC VL 对肥胖患者进行插管的成功率。
使用 McGrath（M 组，n=50）或 C-MAC（C 组，n=50）喉镜对 II/III 级肥胖患者进行插管，使用困难气道评估工具、气道困难评分和总气道评分评估是否存在困难气道。记录最佳声门视图、直接和间接 Cormack-Lehane（CL）评分以及插管时间后进行插管尝试。如果插管失败，使用管芯进行进一步插管尝试，并再次记录插管时间。如果再次插管失败，使用 C-MAC D-Blade 进行第三次尝试。记录插管后的插管难度评分。
两组患者在人口统计学数据、CL 评分降低的患者数量、插管所需尝试次数或首次和第二次插管时间方面均无统计学差异。ADS 评分、TAS 评分、CL 评分 DL 和 CL 评分 IN 是需要第二次插管的重要危险因素，这些患者的 ADS 评分的截断值为 8.50，TAS 评分的截断值为 4.50。在需要第二次插管尝试的 38 名患者中，所有患者均成功，但有 1 名患者需要使用 C-MAC D-Blade 进行第三次插管尝试。
在获得最佳声门视图方面，McGrath 和 C-MAC 均有效且效果相当，且均无插管失败。无论使用哪种视频喉镜，在第一次插管尝试中使用管芯均可提高插管成功率。
