Manhas Samriti, Agrawal Nidhi, Jain Swati, Sharma Ridhima, Choudhary Ripon
Department of Anaesthesia and Critical Care, VMMC and Safdarjung Hospital, New Delhi, India.
Department of Anaesthesia and Critical Care, Guru Teg Bahadur Hospital, Dilshad Garden, East, Delhi, India.
Indian J Anaesth. 2023 Feb;67(Suppl 2):S133-S139. doi: 10.4103/ija.ija_988_22. Epub 2023 Feb 22.
Endotracheal intubation (ET) in infants is considered a challenging task over the decades. Infants have short safe apnoea time, and this difficulty has been vanquished to some extent by using the videolaryngoscopes (VLs), but there exists a dearth of research particularly in this vulnerable subset. Therefore, this trial was conducted to evaluate intubation times obtained with C-MAC VL and conventional Miller laryngoscopes in infants.
A total of 80 infants aged between 1 month and 1 year with American Society of Anesthesiologists physical status I-II requiring ET were randomised in two groups; the C-MAC VL or Miller laryngoscope ML. Anaesthesia was induced with sevoflurane 1-8% and atracurium 0.5 mg/kg IV. The primary outcome was evaluated as the total time taken to intubate. Secondary outcomes were time to achieve best glottic view (TBGV), tube insertion time (TIT), percentage of glottic opening (POGO) score, number of attempts and intubation difficulty score (IDS).
The median (interquartile range) of time taken for ET was less in VL; 22.5 (20.75-26) compared to ML; 26 (21.75-31). TBGV was achieved early in VL group than the ML group (6.03 ± 1.33s/7.88 ± 2.44) respectively (P-value < 0.001). POGO was better in VL (99.12 ± 4.795s) compared to ML (85.50 ± 31.13s). IDS was less in the VL group (0.07 ± 0.27) than in ML (0.70 ± 1.14). Other parameters, such as the number of attempts, bougie usage, adverse effects and TIT, were comparable across the two groups.
When compared to the ML group, the C-MAC VL group exhibited a decreased intubation time, early TBGV, better POGO score, reduced IDS and subjective intubation difficulty. As a result, we consider VL to be a more efficacious device for intubating the trachea in infants.
几十年来，婴儿气管插管一直被认为是一项具有挑战性的任务。婴儿的安全呼吸暂停时间较短，使用视频喉镜在一定程度上克服了这一困难，但尤其在这个脆弱的亚组中仍缺乏相关研究。因此，本试验旨在评估使用C-MAC视频喉镜和传统米勒喉镜对婴儿进行气管插管的时间。
总共80名年龄在1个月至1岁之间、美国麻醉医师协会身体状况分级为I-II级且需要进行气管插管的婴儿被随机分为两组；C-MAC视频喉镜组或米勒喉镜组。使用1-8%的七氟醚和0.5mg/kg静脉注射阿曲库铵诱导麻醉。主要结局评估为气管插管的总时间。次要结局包括获得最佳声门视野的时间（TBGV）、导管插入时间（TIT）、声门开口百分比（POGO）评分、尝试次数和插管困难评分（IDS）。
视频喉镜组气管插管的中位时间（四分位间距）低于米勒喉镜组；分别为22.5（20.75-26）秒和26（21.75-31）秒。视频喉镜组比米勒喉镜组更早获得最佳声门视野（分别为6.03±1.33秒/7.88±2.44秒）（P值<0.001）。视频喉镜组的声门开口百分比（99.12±4.795秒）优于米勒喉镜组（85.50±31.13秒）。视频喉镜组的插管困难评分（0.07±0.27）低于米勒喉镜组（0.70±1.14）。两组的其他参数，如尝试次数、导丝使用情况、不良反应和导管插入时间，具有可比性。
与米勒喉镜组相比，C-MAC视频喉镜组的气管插管时间缩短，更早获得最佳声门视野，声门开口百分比评分更高，插管困难评分降低，主观插管难度降低。因此，我们认为视频喉镜是一种更有效的婴儿气管插管设备。
