Abdalla Ashraf E, Eissa Mohsen M, Elbasyouny Mohamed R, Zomra Mahmoud R, Elnaggar Ahmed M, Elsayed Mahmoud M
Department of Anesthesia, ICU & Pain, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt.
BMC Anesthesiol. 2025 Jan 10;25(1):24. doi: 10.1186/s12871-024-02841-x.
Endotracheal intubation (ETI) is a life-saving procedure that must be accurately carried on to guard against complications. Presbyopia leads to difficulty in viewing close objects and may obstacle proper intubation even with the best hands.
This study supposed that the use of video-laryngoscope (VL) may provide better intubation conditions for presbyopic anesthetists and targets to evaluate the neonates and infants' intubation success rates (ISR) by anesthetists aged ≥ 45 years using the C-MAC VL compared to the standard laryngoscope (SL).
Thirty-one neonates with an age of 18.2 ± 5.2 days and a body weight of 4.5 ± 0.3 kg and 103 infants aged 8.6 ± 1 months and weighing 9.4 ± 1.5 kg were randomly categorized into the SL group that received ETI using the SL and the VL group had intubated using the C-MAC (Karl Storz, Germany) VL with the standard Miller blade and flexible Stylet (2 mm PORTEX stylet; Smiths Medical International Ltd., UK) to strengthen the endotracheal tube (ETT) and adjust its curvature as C-shaped. The study outcomes included the frequency of successful intubation and the number of intubation attempts.
The ISR was significantly (P < 0.001) higher with significantly (P = 0.0037) lower frequency of using assistance maneuvers with VL. The mean score of the anesthetist's difficulty rating was significantly (P < 0.001) higher with SL (2.7 ± 2) than with VL (1.27 ± 1.27). Times for the full intubation process were significantly (P < 0.001) shorter with VL than SL. The 1st attempt success rate was significantly (P = 0.0195) higher with VL than SL (86.6% vs. 67.2%). The frequency of maneuver-related complications was insignificantly (P = 0.116) reduced with the use of VL (4.5%) than with SL (12%). The ISR showed a negative significant correlation (r=-0.973, P = 0.005) with the anesthetist's age.
Neonatal and infantile intubation using VL is feasible and easy to handle by aged anesthetists and allows higher ISR and 1st attempt rate with minimal need for external assistant maneuvers and maneuver-related complications. VL might be more appropriate for the presbyopic pediatric anesthetists than the SL.
The limitations of the study are the small sample size of anesthetists and the use of one type of VLs.
气管插管术是一项挽救生命的操作，必须准确进行以预防并发症。老花眼会导致近视力困难，即使是技术最娴熟的人也可能妨碍正确插管。
本研究推测，使用视频喉镜（VL）可能为老花眼麻醉医生提供更好的插管条件，并旨在评估45岁及以上麻醉医生使用C-MAC VL与标准喉镜（SL）相比，对新生儿和婴儿的插管成功率（ISR）。
将31例年龄为18.2±5.2天、体重为4.5±0.3千克的新生儿和103例年龄为8.6±1个月、体重为9.4±1.5千克的婴儿随机分为SL组（使用SL进行气管插管）和VL组（使用德国Karl Storz公司的C-MAC VL及标准Miller镜片和柔性管芯（2毫米PORTEX管芯；英国Smiths Medical International Ltd.）对气管导管（ETT）进行加固并调整其弯曲度呈C形进行插管）。研究结果包括插管成功率和插管尝试次数。
VL组的ISR显著更高（P<0.001），使用辅助操作的频率显著更低（P=0.0037）。麻醉医生困难评分的平均分，SL组（2.7±2）显著高于VL组（1.27±1.27）（P<0.001）。VL组完成整个插管过程的时间显著短于SL组（P<0.001）。VL组的首次尝试成功率显著高于SL组（86.6%对67.2%，P=0.0195）。使用VL时与操作相关并发症的发生率（4.5%）较SL组（12%）有非显著降低（P=0.116）。ISR与麻醉医生年龄呈显著负相关（r=-0.973，P=0.005）。
老年麻醉医生使用VL对新生儿和婴儿进行插管是可行且易于操作的，可实现更高的ISR和首次尝试率，且对外部辅助操作及与操作相关并发症的需求最小。对于老花眼儿科麻醉医生而言，VL可能比SL更合适。
本研究的局限性在于麻醉医生样本量小以及仅使用了一种类型的VL。
