成人预期气道管理困难时，斜视角喉镜与麦金托什喉镜的比较：一项随机对照试验

Hyperangulated vs. Macintosh videolaryngoscopy in adults with anticipated difficult airway management: a randomised controlled trial.

作者信息

Köhl Vera, Wünsch Viktor A, Müller Marie-Claire, Sasu Phillip B, Dohrmann Thorsten, Peters Tanja, Tolkmitt Josephine, Dankert André, Krause Linda, Zöllner Christian, Petzoldt Martin

机构信息

Department of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Anaesthesia. 2024 Sep;79(9):957-966. doi: 10.1111/anae.16326. Epub 2024 May 24.

DOI:10.1111/anae.16326

PMID:38789407

Abstract

BACKGROUND

It is not certain whether the blade geometry of videolaryngoscopes, either a hyperangulated or Macintosh shape, affects glottic view, success rate and/or tracheal intubation time in patients with expected difficult airways. We hypothesised that using a hyperangulated videolaryngoscope blade would visualise a higher percentage of glottic opening compared with a Macintosh videolaryngoscope blade in patients with expected difficult airways.

METHODS

We conducted an open-label, patient-blinded, randomised controlled trial in adult patients scheduled to undergo elective ear, nose and throat or oral and maxillofacial surgery, who were anticipated to have a difficult airway. All airway operators were consultant anaesthetists. Patients were allocated randomly to tracheal intubation with either hyperangulated (C-MAC D-BLADE™) or Macintosh videolaryngoscope blades (C-MAC™). The primary outcome was the percentage of glottic opening. First attempt success was designated a key secondary outcome.

RESULTS

We assessed 2540 adults scheduled for elective head and neck surgery for eligibility and included 182 patients with expected difficult airways undergoing orotracheal intubation. The percentage of glottic opening visualised, expressed as median (IQR [range]), was 89 (69-99 [0-100])% with hyperangulated videolaryngoscope blades and 54 (9-90 [0-100])% with Macintosh videolaryngoscope blades (p < 0.001). First-line hyperangulated videolaryngoscopy failed in one patient and Macintosh videolaryngoscopy in 12 patients (13%, p = 0.002). First attempt success rate was 97% with hyperangulated videolaryngoscope blades and 67% with Macintosh videolaryngoscope blades (p < 0.001).

CONCLUSIONS

Glottic view and first attempt success rate were superior with hyperangulated videolaryngoscope blades compared with Macintosh videolaryngoscope blades when used by experienced anaesthetists in patients with difficult airways.

摘要

背景

对于预期气道困难的患者，视频喉镜的叶片几何形状（无论是超角度型还是麦金托什型）是否会影响声门视野、成功率和/或气管插管时间尚不确定。我们假设，在预期气道困难的患者中，与麦金托什视频喉镜叶片相比，使用超角度视频喉镜叶片可使声门开口可视化的比例更高。

方法

我们对计划接受择期耳鼻喉或口腔颌面外科手术、预期气道困难的成年患者进行了一项开放标签、患者盲法、随机对照试验。所有气道操作者均为麻醉科顾问医师。患者被随机分配使用超角度（C-MAC D-BLADE™）或麦金托什视频喉镜叶片（C-MAC™）进行气管插管。主要结局是声门开口的比例。首次尝试成功被指定为关键次要结局。

结果

我们评估了2540名计划进行择期头颈手术的成年人是否符合入选标准，纳入了182名预期气道困难且正在接受经口气管插管的患者。超角度视频喉镜叶片使声门开口可视化的比例，以中位数（四分位间距[范围]）表示，为89（69 - 99[0 - 100]）%，而麦金托什视频喉镜叶片为54（9 - 90[0 - 100]）%（p < 0.001）。一线超角度视频喉镜检查有1例患者失败，麦金托什视频喉镜检查有12例患者失败（13%，p = 0.002）。超角度视频喉镜叶片的首次尝试成功率为97%，麦金托什视频喉镜叶片为67%（p < 0.001）。