Gentry W B, Shanks C A
Department of Anesthesia, Northwestern University Medical School, Chicago, IL 60611.
Anesth Analg. 1993 Jul;77(1):161-3. doi: 10.1213/00000539-199307000-00031.
Confirmation of translaryngeal placement of the tracheal tube can be unexpectedly difficult. This study examined the usefulness of displacing the larynx posteriorly with the tracheal tube during laryngoscopy with a straight laryngoscope blade to confirm tracheal tube placement. One hundred ASA Classes I, II, or III patients presenting for elective surgery whose normal anesthetic care included placement of an orotracheal tube via direct laryngoscopy were enrolled in this institutionally approved study after giving their written, informed consent. The view of the larynx at laryngoscopy was graded, and the tracheal tube was then inserted. When the larynx was incompletely exposed, the tracheal tube was displaced posteriorly while the laryngoscope was maintained in the intubating position in an attempt to better visualize the larynx. The effect of the maneuver on Mallampati grade for laryngeal exposure was noted. During laryngoscopy with a Miller blade none of the glottis was initially visualized in 17 patients (Mallampati laryngeal Grades 3 and 4). Thus, the tracheal tube actually was not seen to pass between these patients' vocal cords. Use of the maneuver resulted in improved visualization of the intubated larynx in 12 of these patients, and confirmed tracheal intubation. This maneuver is recommended as an aid to the anesthesiologist in the confirmation of tracheal intubation.
确认气管导管经喉置入可能会意外地困难。本研究探讨了在使用直喉镜镜片进行喉镜检查时，通过气管导管将喉向后移位以确认气管导管位置的有效性。100例拟行择期手术的ASA I、II或III级患者，其正常麻醉护理包括通过直接喉镜检查置入口气管导管，在获得其书面知情同意后纳入本机构批准的研究。对喉镜检查时的喉部视野进行分级，然后插入气管导管。当喉部暴露不完全时，在喉镜保持插管位置的同时将气管导管向后移位，试图更好地观察喉部。记录该操作对喉部暴露的Mallampati分级的影响。在使用Miller镜片进行喉镜检查时，17例患者（Mallampati喉部分级3级和4级）最初均未看到声门。因此，实际上未观察到气管导管在这些患者的声带之间通过。该操作使其中12例患者的插管喉部视野得到改善，并确认了气管插管。推荐该操作作为麻醉医生确认气管插管的辅助手段。
