Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2023 Oct;76(5):451-460. doi: 10.4097/kja.22733. Epub 2023 Mar 13.
Semi-rigid neck collars to protect the cervical spine can limit the extent of neck movement and mouth opening; this may further complicate orotracheal intubation. We aimed to compare intubation environments obtained with videolaryngoscopy using the technique of gliding a blade under the epiglottis and that obtained using the conventional Macintosh blade technique of blade tip placement on the vallecula.
This prospective randomized study included patients aged ≥ 20 years with American Society of Anesthesiologists physical status I-III scheduled for cervical spine surgery between October 2020 and August 2021. Patients were divided into two groups according to the placement of the blade of the McGrathTM videolaryngoscope: the gliding and conventional groups. The percentage of glottic opening (POGO) score was the primary endpoint. We also recorded the time to obtain the optimal laryngoscopic view, intubation duration, and ease and satisfaction of the researcher performing intubation.
Among 176 patients, the POGO scores were significantly higher in the gliding group than in the conventional group (88.9 ± 14.7 vs. 63.8 ± 27.4, P < 0.001). The time to achieve the optimal glottic view for intubation and duration of intubation were also shorter, and ease and satisfaction in performing intubation were better in the gliding group than in the conventional group.
Our findings demonstrated a superior glottic view and more favorable intubation environments when the blade tip was placed under the epiglottis than using the conventional Macintosh technique in patients with immobilized cervical spine.
保护颈椎的半刚性颈圈可限制颈部活动和张口度；这可能会进一步使经口气管插管复杂化。我们旨在比较使用喉镜下将刀片滑入会厌下的技术和使用传统 Macintosh 刀片将刀片尖端置于杓状软骨上的技术获得的插管环境。
本前瞻性随机研究纳入了 2020 年 10 月至 2021 年 8 月期间计划行颈椎手术的美国麻醉医师协会身体状况 I-III 级的≥20 岁患者。根据 McGrathTM 可视喉镜刀片的放置情况，将患者分为两组：滑行组和常规组。主要终点是声门张开百分比（POGO）评分。我们还记录了获得最佳喉镜视野的时间、插管时间、以及进行插管的研究人员的操作难易程度和满意度。
在 176 例患者中，滑行组的 POGO 评分明显高于常规组（88.9±14.7 vs. 63.8±27.4，P<0.001）。达到最佳声门视野进行插管的时间和插管时间也较短，滑行组的插管操作的难易程度和满意度也优于常规组。
在颈椎固定的患者中，与传统 Macintosh 技术相比，将刀片尖端置于会厌下可获得更好的声门视野和更有利的插管环境。
