Qinye Shi, Tianlun Zhu, Youfa Zhou, Gang Chen
Anesthesia, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, CHN.
Cureus. 2024 Aug 13;16(8):e66802. doi: 10.7759/cureus.66802. eCollection 2024 Aug.
Fiberoptic intubation is an important method for tracheal intubation in patients with cervical spine injury. How to effectively and safely complete fiberoptic intubation while maintaining the stability of the cervical spine is very important. This study compared the efficiency and safety of fiberoptic intubation after anesthesia induction under different types of air pressure in patients with simulated cervical spinal injury.
In total, 59 adult patients who underwent fiberoptic intubation with a cervical collar for simulated cervical spinal injury were randomly allocated to continuous positive-pressure oxygen, normal-pressure, or intermittent negative-pressure suction groups. After the induction of anesthesia and adequate 100% oxygenation, which confirmed effective neuromuscular blockade, it was deemed appropriate to begin fiberoptic intubation. In the continuous positive-pressure oxygen group, the fiberoptic device was connected through the negative-pressure suction path with 5 L/min oxygen. In the intermittent negative-pressure suction group, the fiberoptic device was connected to the negative-pressure suction device. In the normal-pressure group, the flexible fiberoptic device was not connected to either the oxygen source or the negative-pressure suction device. The intubation time was recorded as the primary outcome measure. The intubation success rate, number of attempts, minimum SpO2, objective lens contamination rate, and incidence of complications were also compared among the groups.
Compared with those in the other groups, the median (range) intubation time in the continuous positive-pressure group was 59 (36-181) seconds, which was significantly shorter than that in the normal-pressure group, 167 (46-181) seconds, and the intermittent negative-pressure suction group, 132.5 (38-181) seconds (P=0.04). The success rate of nasotracheal intubation was significantly greater in the continuous positive-pressure group (94.7%, 18/19) than in the normal-pressure group (50%, 10/20) and intermittent negative-pressure suction group (50%, 10/20) (P=0.004). There was a significant difference among the three groups (P=0.043). The median (range) minimum SpO2 during fiberoptic intubation was 100% (99-100%) in the continuous positive-pressure group, 100% (90-100%) in the normal-pressure group, and 99% (88-100%) in the intermittent negative-pressure suction group (P=0.029). However, no statistically significant difference was detected among the groups with complications.
The continuous use of positive-pressure oxygen via the negative-pressure suction pathway can improve the efficiency and safety of fiberoptic intubation in patients with simulated cervical spinal injury after anesthesia induction.
纤维支气管镜引导插管是颈椎损伤患者气管插管的重要方法。如何在维持颈椎稳定性的同时有效且安全地完成纤维支气管镜引导插管非常重要。本研究比较了模拟颈椎损伤患者在不同气压类型下麻醉诱导后纤维支气管镜引导插管的效率和安全性。
总共59例佩戴颈托进行模拟颈椎损伤纤维支气管镜引导插管的成年患者被随机分配至持续正压给氧组、常压组或间歇负压吸引组。在麻醉诱导及充分的100%氧合（确认有效神经肌肉阻滞）后，认为适宜开始纤维支气管镜引导插管。在持续正压给氧组，纤维支气管镜设备通过负压吸引通道连接，氧流量为5L/min。在间歇负压吸引组，纤维支气管镜设备连接至负压吸引装置。在常压组，可弯曲纤维支气管镜设备未连接氧源或负压吸引装置。记录插管时间作为主要结局指标。还比较了各组间的插管成功率、尝试次数、最低血氧饱和度、物镜污染率及并发症发生率。
与其他组相比，持续正压组的中位（范围）插管时间为59（36 - 181）秒，显著短于常压组的167（46 - 181）秒和间歇负压吸引组的132.5（38 - 181）秒（P = 0.04）。持续正压组经鼻气管插管成功率（94.7%，18/19）显著高于常压组（50%，10/20）和间歇负压吸引组（50%，10/20）（P = 0.004）。三组间存在显著差异（P = 0.043）。纤维支气管镜引导插管期间最低血氧饱和度的中位（范围）值在持续正压组为100%（99 - 100%），常压组为100%（90 - 100%），间歇负压吸引组为99%（88 - 100%）（P = 0.029）。然而，各组间并发症发生率无统计学显著差异。
通过负压吸引通道持续给予正压氧可提高模拟颈椎损伤患者麻醉诱导后纤维支气管镜引导插管的效率和安全性。
