Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
BMC Anesthesiol. 2023 Sep 7;23(1):303. doi: 10.1186/s12871-023-02259-x.
During videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods.
Videolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput-C1, C1-C2, and C2-C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time).
Cervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput-C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1-C2 and C2-C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0-35.0] vs. 22.0 [18.0-27.0] s, P < 0.001).
When performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput-C1.
Clinical Research Information Service (number: KCT0006239, date: 10/06/2021).
在可视喉镜插管过程中，直接抬起会厌比间接抬起会厌能提供更高比例的声门显露评分。在这项随机对照试验中，我们比较了两种声门显露方法下手动寰枢椎直线固定下可视喉镜插管时颈椎的运动。
使用 C-MAC® D 叶片在手动寰枢椎直线固定下进行可视喉镜插管：直接（n=51）和间接（n=51）会厌提升组。两组可视喉镜插管时声门显露评分均设定为 50%。主要观察指标为寰枕关节-C1、C1-C2 和 C2-C5 处可视喉镜插管时颈椎的运动。次要观察指标包括插管表现（插管成功率和插管时间）。
直接会厌提升组在寰枕关节-C1 处可视喉镜插管时颈椎运动明显小于间接会厌提升组（平均[标准差]3.9[4.0]° vs. 5.8[3.4]°，P=0.011），而在 C1-C2 和 C2-C5 处两组间无显著差异。两组均在首次尝试时插管成功，均达到声门显露评分 50%的目标。直接会厌提升组的插管时间更长（中位数[四分位间距]29.0[24.0-35.0] vs. 22.0[18.0-27.0]s，P<0.001）。
在手动寰枢椎直线固定下进行可视喉镜插管时，与间接会厌提升相比，直接会厌提升可更有利于减少可视喉镜插管时寰枕关节-C1 处的颈椎运动。
临床研究信息服务（编号：KCT0006239，日期：2021 年 10 月 6 日）。
