Ratajczyk Pawel, Kluj Przemysław, Szmyd Bartosz, Resch Julia, Hogendorf Piotr, Durczynski Adam, Gaszynski Tomasz
Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland.
Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, 90-419 Lodz, Poland.
J Clin Med. 2024 Jan 24;13(3):681. doi: 10.3390/jcm13030681.
The primary objective of this study was to demonstrate whether the Miller blade laryngoscope could provide better visualization of the vocal cords in morbidly obese patients than the Macintosh blade laryngoscope. The secondary objective was to identify the patient-measured factors associated with better visualization of the vocal cords when using the Miller vs. Macintosh blade, as well as whether the application of external pressure might improve the visibility of the glottis during intubation. A prospective, observational study encompassing 110 patients with a BMI > 40 undergoing elective bariatric surgery and intubation procedure was performed. The evaluation of the vocal cords was performed according to the Cormack-Lehane scale and POGO scale in the same patient during intubation, performed with a Miller and a Macintosh blade laryngoscope, in a random matter. The following parameters were assessed: body weight, height, BMI, neck circumference, thyromental distance, sternomental distance, mouth opening, and Mallampati scale and their impact on visualization of the vocal cords using the Miller blade without the application of external pressure. The Miller blade provides an improved view of the glottis compared to the Macintosh blade measured with both the Cormac-Lehane scale (45 (40.91%) without external pressure application on the larynx, and 18 (16.36%) with external pressure application on the larynx) and the POGO scale (45 (40.91%) without external pressure application on the larynx, and 19 (17.27%) with external pressure application on the larynx). The application of laryngeal pressure improved the view of the glottis. Among the measured features, a significant improvement in the visibility of the glottis could be found in patients with a BMI over 44.244 kg/m and a neck circumference over 46 cm. To conclude, the usage of the Miller blade improves the visibility of the glottis compared to the Macintosh blade in morbidly obese patients. The recommendation to use the Miller blade in this group of patients requires further investigation, taking into account the effectiveness of the intubation. Trial Registration: NCT05494463.
本研究的主要目的是证明米勒喉镜在病态肥胖患者中是否比麦金托什喉镜能更好地观察声带。次要目的是确定在使用米勒喉镜与麦金托什喉镜时，与更好地观察声带相关的患者测量因素，以及在插管过程中施加外部压力是否能改善声门的可视性。对110例BMI>40且接受择期减肥手术和插管程序的患者进行了一项前瞻性观察研究。在插管过程中，使用米勒喉镜和麦金托什喉镜对同一患者按照科马克-莱汉内量表和POGO量表对声带进行评估，评估过程随机进行。评估了以下参数：体重、身高、BMI、颈围、甲状软骨-颏下距离、胸骨-颏下距离、开口度和马兰帕蒂分级，以及它们在不施加外部压力的情况下使用米勒喉镜时对声带可视性的影响。与麦金托什喉镜相比，使用科马克-莱汉内量表（在喉部不施加外部压力时为45例（40.91%），在喉部施加外部压力时为18例（16.36%））和POGO量表（在喉部不施加外部压力时为45例（40.91%），在喉部施加外部压力时为19例（十七点二七%））测量，米勒喉镜能更好地观察声门。施加喉部压力可改善声门的可视性。在测量的特征中，BMI超过44.244kg/m且颈围超过46cm的患者声门可视性有显著改善。总之，在病态肥胖患者中，与麦金托什喉镜相比，使用米勒喉镜可提高声门的可视性。考虑到插管的有效性，建议在这组患者中使用米勒喉镜还需要进一步研究。试验注册号：NCT05494463。
