使用带通道和不带通道的视频喉镜比较仰卧位（嗅物位）和背部抬高25°体位下的插管条件——一项随机对照研究。

Comparison of intubating conditions in supine (sniffing) and 25° back-up position using channelled and non-channelled video laryngoscopes - A randomised controlled study.

作者信息

Desai Devyani, Sompura Riddhi, Yadav Sudarshan

机构信息

Department of Anaesthesiology, Baroda Medical College, Vadodara, Gujarat, India.

出版信息

Indian J Anaesth. 2023 Dec;67(12):1090-1095. doi: 10.4103/ija.ija_662_23. Epub 2023 Dec 13.

DOI:10.4103/ija.ija_662_23

PMID:38343674

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10858694/

Abstract

BACKGROUND AND AIMS

The 25°back-up position is proposed to increase the efficacy of preoxygenation and provide better tracheal intubating conditions when using a direct laryngoscope. This study aimed to compare the ease of tracheal intubation between supine and 25° back-up positions when using two video laryngoscopes (VLS).

METHODS

One hundred adults with normal airways and belonging to the American Society of Anesthesiologists physical status classes I and II, requiring general anaesthesia, were randomised in groups K and M. The trachea was intubated using King Vision and McGrath VLS in either supine (groups K1 and M1) or 25° back-up (groups K2 and M2) positions. The 25° backup position was given by raising the operating table from the horizontal position by flexing the torso at the hips so that an imaginary line connected the patient's external auditory meatus to the sternal notch. Modified Intubation Difficulty Scale (mIDS) was the primary outcome, and intubation time, the number of intubation attempts, vital parameters, and complications were compared secondarily. Statistical analysis was done using MedCalc software by applying an independent -test for parametric data and a Chi-square test for categorical data and finding the risk ratio.

RESULT

Mean (Standard deviation) mIDS was significantly reduced using both VLS in the 25° back-up position [0.92 (0.75) versus 0.48 (0.58), = 0.025, degree of freedom (DF): 48, mean difference (95% confidence interval [CI]):-0.44 (-0.821 to - 0.059) in group K1 versus group K2 and 0.76 (0.59) versus 0.36 (0.48), = 0.012, DF: 48, mean difference (95% CI): -0.40(-0.706 to - 0.094) in group M1 versus group M2, respectively]. The risk ratio comparing both the positions for the total number of patients requiring manoeuvres during intubation using both the VLS was 0.48 with = 0.0004 and 95% CI = 0.305 - 0.765. Intubation time was shorter in the 25° backup position by using King Vision = 0.005) and McGrath = 0.042) VLS.

CONCLUSION

The 25° backup position helps provide ease of intubation using both the channelled (King Vision) and non-channelled (McGrath) VLS.

摘要

背景与目的

有人提出采用25°后仰位可提高预充氧效果，并在使用直接喉镜时提供更好的气管插管条件。本研究旨在比较使用两种视频喉镜（VLS）时，仰卧位与25°后仰位气管插管的难易程度。

方法

100例气道正常、美国麻醉医师协会身体状况分级为Ⅰ级和Ⅱ级、需要全身麻醉的成年人被随机分为K组和M组。使用King Vision和McGrath VLS在仰卧位（K1组和M1组）或25°后仰位（K2组和M2组）进行气管插管。25°后仰位通过将手术台从水平位置抬起，使患者髋部躯干弯曲，从而使一条假想线连接患者外耳道与胸骨切迹来实现。改良插管难度量表（mIDS）是主要观察指标，次要观察指标包括插管时间、插管尝试次数、生命体征参数和并发症。使用MedCalc软件进行统计分析，对参数数据应用独立t检验，对分类数据应用卡方检验，并计算风险比。

结果

在25°后仰位使用两种VLS时，平均（标准差）mIDS均显著降低[K1组与K2组分别为0.92（0.75）对0.48（0.58），P = 0.025，自由度（DF）：48，平均差值（95%置信区间[CI]）：-0.44（-0.821至-0.059）；M1组与M2组分别为0.76（0.59）对0.36（0.48），P = 0.012，DF：48，平均差值（95%CI）：-0.40（-0.706至-0.094）]。比较两种VLS在插管过程中需要操作的患者总数时，两种体位的风险比为0.48，P = 0.0004，95%CI = 0.305 - 0.765。使用King Vision（P = 0.005）和McGrath（P = 0.042）VLS时，25°后仰位的插管时间更短。