Léon O, Benhamou D
Département d'anesthésie-réanimation chirurgicale, hôpital Antoine-Béclère, Clamart, France.
Ann Fr Anesth Reanim. 1998;17(1):68-71. doi: 10.1016/s0750-7658(97)80188-8.
Difficult intubation remains one of the major risks in anaesthetic practice. Recently, as other anaesthetic societies, the French Society for Anaesthesia and Intensive Care (SFAR) has produced algorithms for the management of a difficult intubation. New laryngoscopes and blades have been marketed in recent years, however their place in these algorithms remains unclear. In this preliminary study, we compared the laryngoscopic view in 100 consecutive patients during tracheal intubation with the McCoy laryngoscope first in its normal position and after levering the distal part of the blade. All patients were included in Mallampati classes 1 and 2. Among them, 16% were classified as Cormack and Lehane grades 3 or 4 when using the blade in the normal position. These data confirm previous observations showing that the McCoy blade in normal position performs poorly as compared with the Macintosh blade. Conversely the levering of the distal part of the blade significantly decreased the incidence of Cormack and Lehane grades of 3 or 4 (2 versus 16%, P = 0.001). It is concluded that the McCoy blade is not convenient for its routine use in patients not to be at preoperatively known risk of difficult intubation. This blade significantly improves intubating conditions. Defining the exact place of this new blade in difficult intubation algorithms requires further studies.
困难气道插管仍然是麻醉实践中的主要风险之一。最近，与其他麻醉学会一样，法国麻醉与重症监护学会（SFAR）制定了困难气道插管管理的算法。近年来，新型喉镜及镜片已投放市场，但其在这些算法中的地位仍不明确。在这项初步研究中，我们对100例连续气管插管患者在使用麦考伊喉镜时，先观察其正常位置下的喉镜视野，然后观察抬起镜片远端后的喉镜视野进行了比较。所有患者均属于马兰帕蒂分级1级和2级。其中，在镜片处于正常位置时，16%的患者被归类为科马克和莱汉内分级3级或4级。这些数据证实了先前的观察结果，即正常位置的麦考伊镜片与麦金托什镜片相比表现较差。相反，抬起镜片远端显著降低了科马克和莱汉内分级3级或4级的发生率（2%对16%，P = 0.001）。得出的结论是，对于术前未知有困难气道插管风险的患者，麦考伊镜片不便于常规使用。该镜片能显著改善插管条件。确定这种新型镜片在困难气道插管算法中的确切地位需要进一步研究。
