Rahendra Rahendra, Sesario Fajar, Ramlan Andi Ade Wijaya, Zahra Raihanita, Kapuangan Christopher, Marsaban Arif Hari Martono, Perdana Aries
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia.
Department of Anesthesiology and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Anesth Pain Med (Seoul). 2024 Oct;19(Suppl 1):S113-S120. doi: 10.17085/apm.24018. Epub 2024 Aug 2.
Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle.
This controlled trial randomized fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects.
The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type.
Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.
由于儿童气道尺寸较小、与成人相比解剖结构比例不同以及低氧血症风险较高，儿童气道管理具有挑战性。可以通过使用柔性管芯手动扭转螺旋气管内导管（ETT）以操纵其形状和角度来提高小儿插管的效率。
这项对照试验将50名年龄在1个月至6岁之间、在全身麻醉下接受择期手术的儿童随机分为两组（螺旋ETT [sETT]组和无管芯ETT/标准ETT组）。sETT是使用手工工具扭转ETT形成的。主要目的是确定与标准ETT相比，sETT在缩短插管时间方面的有效性。次要目的是ETT放置准确性、首次尝试插管成功率和不良反应。
与无管芯ETT组相比，sETT组的平均总导管操作时间明显更短（sETT 16.8±3.6秒 vs. 标准ETT 18.8±3.7秒；P = 0.049）。sETT放置的中央放置准确性明显更高（优势比，4.846；95%置信区间，1.287 - 18.255；P = 0.015）。然而，首次尝试成功插管率（sETT 80% vs. 标准ETT 64%，P = 0.208）和总插管时间（sETT：46.5±5.2秒 vs. 标准ETT 48.4±4.9秒；P = 0.205）没有显著差异。两种ETT类型均未观察到不良反应。
螺旋ETT可有效缩短儿童使用视频喉镜时的总导管操作时间，并提高ETT放置准确性。
