Watts A D, Gelb A W, Bach D B, Pelz D M
London Health Sciences Centre, Ontario, Canada.
Anesthesiology. 1997 Dec;87(6):1335-42. doi: 10.1097/00000542-199712000-00012.
In the emergency trauma situation, in-line stabilization (ILS) of the cervical spine is used to reduce head and neck extension during laryngoscopy. The Bullard laryngoscope may result in less cervical spine movement than the Macintosh laryngoscope. The aim of this study was to compare cervical spine extension (measured radiographically) and time to intubation with the Bullard and Macintosh laryngoscopes during a simulated emergency with cervical spine precautions taken.
Twenty-nine patients requiring general anesthesia and endotracheal intubation were studied. Patients were placed on a rigid board and anesthesia was induced. Laryngoscopy was performed on four occasions: with the Bullard and Macintosh laryngoscopes both with and without manual ILS. Cricoid pressure was applied with ILS. To determine cervical spine extension, radiographs were exposed before and during laryngoscopy. Times to intubation and grade view of the larynx were also compared.
Cervical spine extension (occiput-C5) was greatest with the Macintosh laryngoscope (25.9 degrees +/- 2.8 degrees). Extension was reduced when using the Macintosh laryngoscope with ILS (12.9 +/- 2.1 degrees) and the Bullard laryngoscope without stabilization (12.6 +/- 1.8 degrees; P < 0.05). Times to intubation were similar for the Macintosh laryngoscope with ILS (20.3 +/- 12.8 s) and for the Bullard without ILS (25.6 +/- 10.4 s). Manual ILS with the Bullard laryngoscope results in further reduction in cervical spine extension (5.6 +/- 1.5 degrees) but prolongs time to intubation (40.3 +/- 19.5 s; P < 0.05).
Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.
在紧急创伤情况下，颈椎的轴向稳定（ILS）用于减少喉镜检查期间头部和颈部的伸展。与麦金托什喉镜相比，布拉德喉镜可能导致颈椎的移动较少。本研究的目的是在采取颈椎预防措施的模拟紧急情况下，比较使用布拉德喉镜和麦金托什喉镜时颈椎的伸展情况（通过影像学测量）以及插管时间。
对29例需要全身麻醉和气管插管的患者进行研究。患者被放置在硬板上并诱导麻醉。进行四次喉镜检查：分别使用布拉德喉镜和麦金托什喉镜，且均在有无手动ILS的情况下进行。在ILS时施加环状软骨压迫。为了确定颈椎的伸展情况，在喉镜检查前和检查期间拍摄X线片。还比较了插管时间和喉镜下的视野分级。
使用麦金托什喉镜时颈椎伸展（枕骨 - C5）最大（25.9度±2.8度）。使用带ILS的麦金托什喉镜时伸展减少（12.9±2.1度），使用无稳定装置的布拉德喉镜时伸展也减少（12.6±1.8度；P < 0.05）。带ILS的麦金托什喉镜的插管时间（20.3±12.8秒）与无ILS的布拉德喉镜的插管时间（25.6±10.4秒）相似。使用布拉德喉镜时手动ILS可进一步减少颈椎伸展（5.6±1.5度），但会延长插管时间（40.3±19.5秒；P < 0.05）。
带ILS的麦金托什喉镜和无ILS的布拉德喉镜在颈椎伸展和插管时间方面相似。然而，在采取颈椎预防措施的模拟紧急情况下使用布拉德喉镜时，插管时间会显著延长。这表明当插管时间不关键时，布拉德喉镜可能是潜在颈椎损伤患者插管的有用辅助工具。
