Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D,Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial

BackgroundThe use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario.ObjectiveWe compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin.MethodsThirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation.ResultsAll participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42 s, 56 s, and 56 s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29 s and 40 s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation.ConclusionsIn an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.     

喉上神经阻滞用于经口清醒气管插管的临床疗效分析

目的:探讨喉上神经阻滞用于经口清醒气管插管的临床效果。方法:选取拟于全麻下行择期颈椎手术的患者60例,按随机数字表法分为2组,喉上神经阻滞组(S组,30例)和对照组(C组,30例)。记录2组入室后10 min(T1)、纤支镜通过咽部即刻(T2)、纤支镜通过声门即刻(T3)、气管导管通过声门即刻(T4)4个时间点的脉搏血氧饱和度(SpO_2)、心率(heart rate,HR)、平均动脉压(mean arterial pressure, MAP)以及一次插管成功率、声带活动度、呛咳程度、患者满意度及相关并发症。结果:所有患者均一次性完成气管插管,未出现低氧血症,无相关严重并发症发生。喉上神经阻滞操作时间为(1.29±0.29)min。S组声带活动度、呛咳程度及患者满意度评分均显著优于C组(P0.05)。S组T3、T4时间点MAP和HR均显著低于C组(P0.05)。结论:采用喉上神经阻滞不影响一次插管成功率,能提供更好的清醒气管插管条件,插管过程中声带活动度低,呛咳程度轻,血流动力学更稳定,患者满意度高,且无相关严重并发症发生。     

Risk Factors for Failed Tracheal Intubation in Pediatric and Neonatal Critical Care Specialty Transport

Abstract

Objective. Nearly 200,000 pediatric and neonatal transports occur in the United States each year with some patients requiring tracheal intubation. First-pass intubation rates in both pediatric and adult transport literature are variable as are the factors that influence intubation success. This study sought to determine risk factors for failed tracheal intubation in neonatal and pediatric transport. Methods. A retrospective chart review was performed over a 2.5-year period. Data were collected from a hospital-based neonatal/pediatric critical care transport team that transports 2,500 patients annually, serving 12,000 square miles. Patients were eligible if they were transported and tracheally intubated by the critical care transport team. Patients were categorized into two groups for data analysis: (1) no failed intubation attempts and (2) at least one failed intubation attempt. Data were tabulated using Epi Info Version 3.5.1 and analyzed using SPSSv17.0. Results. A total of 167 patients were eligible for enrollment and were cohorted by age (48% pediatric versus 52% neonatal). Neonates were more likely to require multiple attempts at intubation when compared to the pediatric population (69.6% versus 30.4%, p = 0.001). Use of benzodiazepines and neuromuscular blockade was associated with increased successful first attempt intubation rates (p = 0.001 and 0.008, respectively). Use of opiate premedication was not associated with first-attempt intubation success. The presence of comorbid condition(s) was associated with at least one failed intubation attempt (p = 0.006). Factors identified with increasing odds of at least one intubation failure included, neonatal patients (OR 3.01), tracheal tube size ≤ 2.5 mm (OR 3.78), use of an uncuffed tracheal tube (OR 6.85), and the presence of a comorbid conditions (OR 2.64). Conclusions. There were higher rates of tracheal intubation failure in transported neonates when compared to pediatric patients. This risk may be related to the lack of benzodiazepine and neuromuscular blocking agents used to facilitate intubation. The presence of a comorbid condition is associated with a higher risk of tracheal intubation failure.     

A randomized comparison of rescuer positions for intubation on the ground

Objective. To examine the ease of endotracheal intubation on the ground for various rescuer positions.

Methods. Six female and 18 male emergency medical technicians were asked to intubate a Laerdal Megacode Trainer placed on the ground, Rescuers assumed the following positions in random order: prone, sitting, kneeling at the mannequin's head, and straddling the chest. The authors measured times 1) for changing from mask ventilation to assuming intubation position and 2) from touching the laryngoscope to putting it down. Incidences of esophageal tube placement and clicks (possible tooth damage) were noted. The rescuers rated their satisfaction with each position on a six-point scale (1 = very good, 6 = insufficient). Total intubation times of the other three positions were compared with that for prone by rank order test for paired observations. Handling, esophageal positions, and clicks of the other three positions were compared with those for prone by sign test for paired observations. A Bonferroni correction (factor 12) was applied.

Results. Mean total intubation times (in seconds) were 11.8 ± 3.3 for prone, 13.9 ± 4.7 for sitting, 11.4 ± 4.5 for kneeling, and 16.2 ± 5.8 for straddling. The difference between straddling and prone was statistically significant (p < 0.005). For handling, the results were for prone 3.0 ± 1.4, for sitting 3.1 ± 1.1, for kneeling 2.2 ± 0.6, and for straddling 2.8 ± 1.4. Esophageal positions occurred for prone 1, for sitting 1, for kneeling 2, and for straddling 3. Clicks were counted for prone 2, for sitting 1, for kneeling 1, and for straddling 0.

Conclusions. All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.     

超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果

目的 探讨超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果。方法 选择2018年1月－2020年1月该院收治的120例拟行气管插管全身麻醉的肥胖患者作为研究对象,使用随机数表法将患者分为两组,每组各60例。观察组采用超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,对照组采用超声引导下喉上神经阻滞联合传统光学喉镜气管插管。观察两组患者声门显露成功率、一次性气管插管成功率、总插管成功率、成功插管的平均插管时间、插管过程中呛咳发生率以及呛咳程度、血流动力学和插管相关并发症发生情况。结果 观察组声门显露成功率、一次性气管插管成功率高于对照组（P < 0.05）,成功插管的平均插管时间短于对照组（P < 0.05）,插管后1 min（T₁）和5 min（T₂）患者心率（HR）、无创收缩压（SBP）和无创舒张压（DBP）低于对照组（P < 0.05）,经皮动脉血氧饱和度（SpO₂）高于对照组（P < 0.05）,口腔出血、咽喉部损伤和气道损伤等并发症总发生率低于对照组（P < 0.05）。结论 超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,可提高肥胖患者声门显露成功率和一次性插管成功率,缓解血流动力学波动,减少插管相关并发症发生风险。     

成人支气管异物的支气管镜下表现和介入治疗方式探讨

目的 探讨成人支气管异物支气管镜下表现和介入治疗方式。方法 回顾性分析空军军医大学唐都医院呼吸与危重症医学科2014年1月－2019年4月129例经支气管镜检查确诊的成人支气管异物患者支气管镜下表现、介入治疗方式及预后等临床资料。结果 129例患者中,88例为局麻经鼻进镜,33例患者全麻完成检查治疗,8例患者局麻下发现异物后经全麻下取出异物。取出异物的128例患者中,29例直视下可见异物,未造成管壁管腔黏膜改变;65例直视下见部分异物伴周围肉芽组织增生;23例管壁肉芽组织生长致管腔堵塞,清除部分肉芽后异物暴露;6例患者气道分泌物致管腔堵塞,吸除分泌物后见异物;4例异物嵌顿;1例超细支气管镜下未见异常,后经支气管内超声导向鞘引导（EBUS-GS）探及明显边界回声灶,活检钳钳夹确定为异物。129例异物患者中取出128例,镜下吸引取出2例。使用一种介入手段取出95例,较为常用的手段包括冷冻（28例）、活检钳（27例）、异物钳（25例）、异物网篮（10例）;使用两种介入手段取出25例,最常用的手段包括活检钳+冷冻（11例）;使用三种及以上介入手段取出6例。所有患者术后无出血、气胸、穿孔及窒息等严重并发症发生。所有患者中124例痊愈,1例因本身合并气道狭窄,多次镜下治疗后病情好转,3例异物吸入时间过长导致原异物所在部位形成局部支气管扩张,1例患者因全麻支气管镜下采用多种方式仍无法取出异物,建议手术,患者家属放弃治疗。结论 支气管镜检查是诊断及治疗成人支气管异物安全有效的方法,值得推广。     

Thoracotomy for tracheal disruption after traumatic intubation: a case report

Tracheal dissection is an uncommon complication of endotracheal intubation. A large source of morbidity and mortality in anesthesia is associated with airway issues. Several airway complications can be avoided or minimized by proper technique and vigilance. Emergency thoracotomy surgery is required in patients who suffer lower tracheal trauma. A tracheal tear poses additional challenges to traditional airway management, demanding vigilant planning and collaboration among the entire operative team. This case report details the airway management strategies employed during an emergent thoracotomy for a patient who suffered tracheal perforation during endotracheal intubation. A discussion of airway anatomy, airway considerations, intubation complications, and one-lung ventilation techniques is provided. Airway management techniques for one-lung ventilation are highly variable, requiring an extensive knowledge of equipment, clinical implications, and technical challenges. It is important for clinicians to be skilled in the use of several airway devices and to be prepared for any unexpected situation such as the case being presented.     

Severe hypernatremia and gastric dilation from chronic eating disorder and intentional salt ingestion

We report the case of a 21-year-old female presenting with severe hypernatremia and a gastric outlet obstruction due to chronic purging behavior with salt water flushes. She presented obtunded following emesis and a witnessed seizure. She was found to have a corrected sodium level of 177 mmol/L. Following initial intubation and resuscitation, her CT imaging showed massive gastric dilation with high-density material in the gastric lumen. After orogastric flushing was unsuccessful and the patient's abdominal distention worsened, she was managed surgically and found to have a salt bezoar leading to bowel ischemia and perforation. This case details the complications and management of acute hypernatremia and gastric outlet obstruction in an otherwise healthy, young female. In a society where eating disorders are pervasive, Emergency Medicine physicians should be familiar with dangerous dietary behaviors as well as the management of their rare, but potentially life-threatening, complications.     

Anti-Yo antibody-positive paraneoplastic cerebellar degeneration in a patient with possible cholangiocarcinoma: A case report and review of the literature

BACKGROUNDParaneoplastic cerebellar degeneration (PCD), which is rare in clinical practice, is closely related to autoimmunity. Cases positive for anti-Yo antibodies (anti-Purkinje cytoplasmic antibody 1) are the main subtype of PCD. PCD is subacute cerebellar degeneration, and while it progresses over weeks to months, its resultant deficits last much longer. Cancer patients with anti-Yo antibody-positive PCD are very rare. Most of them are breast cancer or ovarian cancer patients but also occasionally lung cancer patients.CASE SUMMARYA 61-year-old woman presented with sudden vertigo, nausea, and vomiting for approximately 10 d. The patient''s neurological examination showed torsion with downbeat nystagmus and ataxia of the right limb and trunk. Laboratory examination found that the patient''s cerebrospinal fluid and serum were anti-Yo antibody-positive, positron emission tomography computed tomography showed an increased metabolic rate in the retroperitoneal lymph nodes, and the pathology of lymph node punctures in the retroperitoneum and neck suggested adenocarcinoma of the pancreaticobiliary duct, which strengthens the hypothesis of paraneoplastic origin. Intravenous immunoglobulin (IVIg) 0.4 g/kg/d for 5 d and methylprednisolone 160 mg for 3 d were initiated, which was reduced to 80 mg for 3 d and then to 40 mg for 7 d. After treatment with IVIg and a steroid, the patient''s vertigo and ataxia alleviated.CONCLUSIONThe patient''s vertigo and ataxia alleviated after treatment, suggesting that early immunotherapeutic intervention may have certain value in stopping neurological loss.     

预见性气管插管治疗急性重度药物中毒临床观察

目的:探讨重度药物中毒患者的气管插管时机对治疗效果的影响。方法:对57例出现呼吸困难的重度药物中毒患者,进行密切观察,在常规治疗的基础上,随机分为预见性气管插管组与延时气管插管组;以并发症发生情况及抢救成功率进行统计学处理,比较两组患者的抢救效果。结果:各种并发症发生情况两组比较P>0.05差异无统计学意义,可能与中毒的量及中毒时间有关;不同时机气管插管抢救成功率两组比较P<0.05,有一定的可比性。结论:预见性气管插管有助于重度药物中毒患者的抢救,气管插管最佳时机为呼吸衰竭早期。     

HC 可视喉镜在急诊低年资住院医师紧急气管插管操作中的应用

目的：研究采用 HC 可视喉镜是否可以提高急诊低年资住院医师紧急气管插管的效率及成功率。方法选取急诊科需要进行紧急气管插管的患者共计80例,首先随机（随机数字法）分为低年资住院医师组（A 组）及高年资主治医师组（B 组）,然后每组再随机分为 HC 可视喉镜插管组（HC 组）及传统光学喉镜插管组（N 组）,比较每组的声门暴露成功率、一次插管成功率、插管总成功率、并发症情况以及成功插管病例的平均尝试次数和平均插管时间。结果（1）A-HC组的声门暴露成功率、一次插管成功率、插管总成功率依次为90％、70％、90％,均高于 A-N 组,依次为50％、20％、45％,P ＜0.05;并发症总发生率、成功插管病例的平均尝试次数、平均插管时间依次为15％、（1.28±0.43）次、（31.44±5.06）s,均低于 A-N 组,依次为45％、（1.89±0.79）次、（45.89±4.99）s,P ＜0.05;（2）B-N 组的声门暴露成功率、一次插管成功率、插管总成功率依次为80％、65％、80％,均高于 A-N 组,依次为50％、20％、45％,P ＜0.05;并发症总发生率、成功插管病例的平均尝试次数、平均插管时间依次为15％、（1.25±0.41）次、（39.31±4.23）s,均低于 A-N 组,依次为45％、（1.89±0.79）次、（45.89±4.99）s,P ＜0.05;（3）A-HC 组与 B-HC 组的上述各项指标比较,差异无统计学意义（P ＞0.05）。结论 HC 可视喉镜用于急诊低年资住院医师的紧急气管插管操作时,可提高声门暴露成功率、减少尝试次数、降低并发症发生率、缩短插管时间,可以提高紧急气管插管的效率及成功率,并且可能缩小其与高年资主治医师紧急气管插管操作的差距。     

Ivan Magill: Forceps for intratracheal anesthesia

Nasal tracheal intubation is a standard airway management technique in emergency medicine. Although possessing a number of advantages, this procedure, when performed under laryngoscopic visualization, possesses all the complications of oral endotracheal intubation. In addition, a number of complications are specific to this airway technique, including epistaxis, perforation of the posterior pharyngeal wall, trauma to the adenoids, rupture of the endotracheal tube balloon, and transient bacteremia. The procedure was first described in 1920 by two anesthesiologists, Stanley Rowbotham and Ivan Magill. Each developed a device to aid the insertion of the tip of the endotracheal tube into the glottis. Magill's forceps are still the instrument of choice for nasal tracheal intubation carried out under laryngoscopic visualization.     

Prehospital Standardization of Medical Airway Management: Incidence and Risk Factors of Difficult Airway

Objectives: The rate of difficult intubation in prehospital emergency medicine varies greatly among studies already published and depends on several factors. The authors' objective was to determine the rate of difficult intubations and to determine factors associated with prehospital difficult airways when a standard protocol for sedation and intubation was applied. Methods: This 30‐month clinical, observational, prospective study was performed in a suburb of Paris, France (Val de Marne, population 1,300,000) by a prehospital emergency medical unit. Airway management for patients who needed tracheal intubation was standardized. The pharmacological procedure recommended rapid sequence intubation for patients with spontaneous cardiac activity. In cases of difficult, laryngoscopy‐assisted intubation, a predefined algorithm was proposed. The Intubation Difficulty Score (IDS) was calculated for all patients requiring tracheal intubation, and factors associated with difficult intubation, defined by IDS of >5, were identified by using multivariate statistical analysis. Results: During the study period, 1,442 patients were included; 640 (44%) were in cardiorespiratory arrest, and 802 had a spontaneous cardiac activity. Deviation from the pharmacological and airway management procedures occurred in 1% of cases. When the predefined difficult airway management algorithm was followed, failure to intubate was encountered twice (0.1%). One hundred six (7.4%) patients had an IDS of >5, and 60 (4.1%) required first (n= 56) then second (n= 4) alternative techniques for tracheal intubation. Semirigid leaders allowed tracheal access in 93% of difficult‐intubation patients. One patient required a prehospital cricothyroidotomy. Factors associated with difficult intubation were the following: a history of ear, nose, or throat neoplasia or surgery; obesity; facial trauma; the operator's status; and the operator's position. Conclusions: If prehospital medical airway management is standardized and performed by trained operators, failure to intubate is rare (0.1%), and the incidence of difficult tracheal intubation is 7.4%, independent of cardiorespiratory status.     

纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用

目的探讨纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用。方法2008年1月至2009年10月收治的慢性阻塞性肺疾病（COPD）并发Ⅱ型呼吸衰竭120例分为纤维支气管镜插管组60例采用纤维支气管镜引导下经鼻气管插管,经口气管插管组60例采用经口气管插管,进行观察。结果纤维支气管镜插管组纤维支气管镜引导下经鼻气管插管全部病例均一次插管成功,一次性插管成功率100％,插管时间1—2min,无一例插管时发生心跳、呼吸骤停,血压下降,气管破裂,气管损伤,咯血等并发症。经口气管插管组由于患者气道分泌物过多、肥胖等原因咽喉暴露不充分出现插管困难7例;插管时发生发生心跳、呼吸骤停3例。结论纤维支气管镜引导下经鼻气管插管明显优于经口管插管具有操作简单,创伤小,并发症发生少,同时可以清理呼吸道,以迅速纠正阻塞、改善通气。     

光棒引导气管插管的临床应用

目的对光棒引导气管插管的操作方法及其有效性、安全性等进行探讨和评价。方法随机选择需气管插管全身麻醉的患者60例,其中男21例,女39例;年龄15～79岁,体重35～110kg,术前预测存在困难气道者3例。采用Tubestat光棒引导气管插管,观察并记录插管时间、插管次数、血流动力学变化及不良反应。结果60例患者中有57例使用光棒插管成功（95％）其中1次插管成功者38例（63％）,试插2次成功者12例,试插3次成功者7例,插管失败3例（5％l插管时间（29．9l±24．21）s。插管后1min与麻醉前比较血流动力学变化无差异;术后诉有轻度咽喉痛者3例,未见其他与插管有关的并发症。结论光棒插管技术简单实用,容易掌握,成功率高,并发症少,可作为麻醉科常规气管插管方法。     

Tracheal rupture complicating emergent endotracheal intubation

Tracheal rupture is rare in clinical practice. We present 2 female patients with tracheal rupture after emergent endotracheal intubation from different injury mechanisms; penetrating injury of using stylet during intubation in one case and overinflation of cuff of the endotracheal tube under rapid sequence intubation in another. The lesions of rupture could be detected by bronchoscopy and reconstructive 3-dimensional computed tomography. Both cases received surgical repair without complication. In our report, reconstructive 3-dimensional computed tomography scrupulously detected the rupture sites and provided the noninvasive modality for diagnosis. We review the literature of tracheal rupture after emergent endotracheal intubation in respects of the diagnosis, the possible mechanisms of the injury, and suggest strategies of management.     

An Unusual Cause of Intubating Laryngeal Mask Obstruction Preventing Successful Intubation in the Emergency Department

BackgroundThe intubating laryngeal mask airway (ILMA) allows providers to blindly intubate through the device. We report a case of foreign material obstructing passage of an endotracheal tube (ET) through an ILMA.Case ReportA 45-year-old man with unknown past medical history was found obtunded with an apparent intentional drug and alcohol overdose, and required tracheal intubation. We opted to use an ILMA to optimize preoxygenation prior to intubation. His upper dentures were removed and an ILMA was inserted without complication; ventilation was easily performed. Blind tracheal intubation was attempted; the ET was inserted through the ILMA and was unable to be advanced past 15 cm despite multiple attempts, including repositioning the ILMA and rotating the ET. The ILMA was removed to prepare for video laryngoscopy. He was subsequently successfully intubated using a standard geometry video laryngoscope, which showed no anatomical abnormalities. After the case, the ILMA was inspected and the bowl of the ILMA was found to be occluded with denture adhesive.Why Should an Emergency Physician Be Aware of This?This case report demonstrates that it is possible that foreign material within the ILMA can make successful intubation impossible, despite successful placement and ventilation through the device. Maneuvers may be performed to attempt successful ET intubation, but when unsuccessful, removal of the ILMA and alternate airway management must be performed.     

Rupture of an Ascending and Descending Thoracic Aortic Aneurysm Causing Tension Hemothorax: A Case Report

Background: A ruptured thoracic aortic aneurysm is a life-threatening condition and can lead to a tension hemothorax. Objectives: To describe the presentation and management of a case of a tension hemothorax. Case Report: An 84-year-old woman presented in respiratory distress and was found to have a tension hemothorax. The cause was the rupture of an ascending and descending thoracic aortic aneurysm. She was managed with intubation, mechanical ventilation, and chest tube placement with stabilization. Definitive operative repair was deferred due to the patient's comorbidities and wishes of the family. Conclusions/Summary: A tension hemothorax can result from an ascending and descending thoracic aneurysm, as this case describes. Emergent therapy is necessary as this is a life-threatening condition.     

Tracheal compression during shoulder arthroscopy in the beach-chair position

Background: Respiratory distress is a rare complication of outpatient shoulder arthroscopy and mostly associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis.Objective: We report on a shoulder arthroscopy complicated by tracheal compression caused by extravasation of irrigation fluid into soft tissues of the upper airway while the patient was in the beach-chair position under general anesthesia.Case Summary: A 33-year-old male was scheduled for shoulder arthroscopy for impingement syndrome of the right shoulder under general anesthesia combined with interscalene brachial plexus block. During the operation, the patient''s neck, right chest, and shoulder were observed to be swollen and tense on palpation. A fiberoptic bronchoscopic evaluation through the endotracheal tube revealed that the trachea was compressed to the left, but not completely obstructed. It was determined that the irrigation fluid had leaked subcutaneously from the shoulder joint to the neck. Vital signs were stable and the patient could be adequately ventilated despite the airway obstruction. The patient was transferred to the ward 16 hours after the operation with stable vital signs and discharged from the hospital on the second day.Conclusions: We report a case of airway obstruction due to tracheal compression from extravasation of irrigation fluid during shoulder arthroscopy under general anesthesia combined with peripheral nerve block in the beach-chair position. General anesthesia with endotracheal intubation protected the patient from a possibly fatal complication.Key words: shoulder arthroscopy, general anesthesia, tracheal compression, beach-chair position     

McCoy 喉镜在气管插管中的应用

目的:观察McCoy 喉镜在气管插管全麻中的作用。方法:120例全麻手术患者随机分为两组,普通喉镜(A),McCoy 喉镜(B)(n=60)。A组:常规监测,全麻诱导后用普通喉镜显露声门,进行气管插管;B组:全麻诱导后,用McCoy喉镜显露声门后行气管插管。分别观察两组喉镜显露程度,记录一次插管成功次数,插管时间,及喉部的损伤,对各项指标进行相关性分析。结果:McCoy 喉镜插管,喉显露情况优于普通喉镜,一次插管成功率高,插管时间短(P<0.05);对喉部的损伤两组无差异性。结论:McCoy 喉镜降低困难插管难度,提高插管成功率, 插管效果优于普通喉镜.