Fisher Q A, Tunkel D E
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Hospital, Baltimore, MD 21287-5842, USA.
J Clin Anesth. 1997 Jun;9(4):275-9. doi: 10.1016/s0952-8180(97)00013-5.
To examine factors contributing to successful lightwand (lighted stylet) intubation of infants and children.
Prospective observational study.
University hospital.
125 children under age 10 years presenting for elective surgery.
Prototype lightwands specifically designed for pediatric patients were used. Intubations were done by anesthesia residents with little or no prior lightwand experience. All attempts were recorded on videotape. In a subgroup of 14 patients, an endoscopic view of the lightwand was also recorded with a flexible nasopharyngoscope.
125 patients with a mean age of 3.0 years (+/- 2.4 years SD; range: 3 weeks to 9 years) were enrolled. 83.2% were intubated using the lightwand, including 75.5% (34 of 45) of infants weighing less than 10 kg. Of the 21 failed intubations, 8 were due to an inappropriately large endotracheal tube, as recognized during direct laryngoscopy; 4 were due to other reasons discussed; and 9 (persistent vallecular or esophageal entry) could not be explained from videotape analysis. Factors contributing to successful intubation included: (1) use of a shoulder roll and slight head extension; (2) conscientious alignment of airway axes; (3) anterior jaw lift to elevate the epiglottis; and (4) gentle handling of the lightwand to avoid displacing soft tissue. Inability to advance the lightwand despite correct glow is caused by entrapment in the vallecula, hang up of the lightwand on the aryepiglottic folds, subglottic narrowing, or vocal cord closure.
Lightwand intubation in children uses both tactile and visual cues regarding the location of the endotracheal tube tip. Attention to detail results in a high level of success among novice users of the pediatric lightwand. Endoscopic and external videotaping gave us a means of monitoring the progress of mechanical skills among novice users.
探讨有助于婴幼儿和儿童使用光棒（发光探条）成功插管的因素。
前瞻性观察性研究。
大学医院。
125名10岁以下择期手术患儿。
使用专门为儿科患者设计的光棒原型。插管由几乎没有或完全没有光棒使用经验的麻醉住院医师进行。所有操作均录像记录。在14名患者的亚组中，还用软性鼻咽镜记录了光棒的内镜视野。
纳入125例平均年龄3.0岁（标准差±2.4岁；范围：3周龄至9岁）的患者。83.2%的患者使用光棒成功插管，其中体重小于10kg的婴儿成功率为75.5%（45例中的34例）。21例插管失败中，8例是因为在直接喉镜检查时发现气管内导管尺寸过大；4例是由于其他讨论过的原因；9例（持续的会厌谷或食管进入）通过录像分析无法解释。有助于成功插管的因素包括：（1）使用肩垫并轻度伸展头部；（2）认真调整气道轴线；（3）向前抬起下颌以抬高会厌；（4）轻柔操作光棒以避免移位软组织。尽管光棒发光正常但无法推进是由于被困在会厌谷、光棒挂在杓会厌襞上、声门下狭窄或声带闭合所致。
儿童光棒插管利用了气管导管尖端位置的触觉和视觉线索。注重细节使儿科光棒的新手使用者成功率很高。内镜和外部录像为我们提供了一种监测新手使用者操作技能进展的方法。
