Jain Mamta, Tantia Kunika, Johar Sanjay, Singh Anish Kumar, Bansal Teena, Sharma Jyoti
Department of Anaesthesiology, PGIMS, Rohtak, Haryana, India.
Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep;40(3):416-421. doi: 10.4103/joacp.joacp_443_22. Epub 2023 Oct 18.
Optimal patient positioning and operating table height are essential for an ergonomic posture of an anesthesiologist in which there is minimal or no strain on thewrist during mask ventilation. It also avoids flexion of the neck, lower back, and knee bending at the time of laryngoscopy and intubation.
One hundred eighty patients were randomly allocated to three groups based on different table heights. The height of the table is kept at the mid-sternum level of an anesthesiologist in group 1, at the xiphoid process in group 2, and at the level of umbilicus in group 3. Laryngoscopic view with or without postural changes (exertion at wrist joint, flexion of the neck, lower back, or knee bending) was graded as per Cormack Lehane's (CL) grading. The degree of discomfort experienced by the anesthesiologist during mask ventilation or tracheal intubation was graded subjectively (1 = no discomfort, 2 = mild discomfort, 3 = moderate discomfort, and 4 = severe discomfort) at different table heights. Postural changes required to obtain the best glottic view and quality of endotracheal (ET) intubation (intubation time and attempts required) were also noted. For analysis, quantitative variables were expressed as mean ± SD and compared using unpaired or analysis of variance test. Qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. Results with value <0.05 were considered significant statistically.
Moderate discomfort (strain at wrist joint) during bag-mask ventilation was experienced by the anesthesiologist in a maximum number of patients in group 1 (81.7%). Significant improvement was seen in CL grade after the use of postural modifications in groups 1 and 2 ( value ≤0.05). Greater postural modifications were required during ET intubation at lower table heights (group 3).
It is advisable to adopt higher table positioning in relation to anesthesiologist performing the laryngoscopy for smooth and single-attempt ET intubation since the best laryngoscopic view and intubation with minimal postural modifications was seen at higher table heights (at the mid-sternum level of an anesthesiologist).
对于麻醉医生而言，最佳的患者体位和手术台高度对于保持符合人体工程学的姿势至关重要，在此姿势下，面罩通气时手腕的压力最小或无压力。这也可避免喉镜检查和插管时颈部、下背部的屈曲以及膝盖弯曲。
180例患者根据不同的手术台高度随机分为三组。第一组手术台高度保持在麻醉医生胸骨中部水平，第二组在剑突水平，第三组在脐水平。根据科马克·莱汉内（CL）分级法对面罩通气时有无姿势改变（手腕关节用力、颈部、下背部屈曲或膝盖弯曲）的喉镜视野进行分级。在不同手术台高度下，主观评估麻醉医生在面罩通气或气管插管期间所经历的不适程度（1 = 无不适，2 = 轻度不适，3 = 中度不适，4 = 重度不适）。还记录了获得最佳声门视野和气管内（ET）插管质量（插管时间和所需尝试次数）所需的姿势改变。分析时，定量变量以均值±标准差表示，并使用非配对t检验或方差分析进行比较。定性变量以频率/百分比表示，并使用卡方检验进行比较。P值<0.05的结果被认为具有统计学意义。
第一组中，大多数患者（81.7%）的麻醉医生在面罩通气期间经历了中度不适（手腕关节劳损）。第一组和第二组在采用姿势调整后，CL分级有显著改善（P值≤0.05）。较低手术台高度（第三组）在ET插管期间需要更大的姿势调整。
对于进行喉镜检查的麻醉医生，建议采用较高的手术台位置以实现顺利且单次尝试的ET插管，因为在较高手术台高度（麻醉医生胸骨中部水平）观察到最佳的喉镜视野且姿势调整最少。
