强直性脊柱炎患者TmviewTM EVO2喉镜引导气管插管的效果

气管插管时常采用Macintosh喉镜.困难气道患者声门显露困难,采用Macintosh喉镜引导气管插管易造成插管困难.TruviewTM EVO2喉镜(Treview喉镜)是一种新型的光学间接式插管喉镜,可提高对声门结构的显露,提高气管插管成功率[1-3].本研究拟通过与Macintosh喉镜进行比较,评价强直性脊柱炎患者Truview喉镜引导气管插管的效果.     

TruviewEV02喉镜与Macintosh喉镜用于颈椎活动受限患者气管插管的对比研究

目的评价Truview EVO,喉镜与Macintosh喉镜用于颈椎活动受限患者气管插管的临床应用情况。方法择期颈椎活动受限经口气管插管全麻手术49例,静脉麻醉诱导后,随机先后使用TruviewEVO2喉镜与Macintosh喉镜显露喉部,并采用喉部暴露条件好的喉镜行气管插管。比较2种喉镜Cormack．Lehane（C-L）分级,喉部结构显露时间和声门显露时血流动力学改变。结果TruviewEVO,喉镜组c-L分级显著优于Macintosh喉镜组（Z=-5．488,P=0．000）,喉部结构显露时间明显长于Macintosh喉镜组[（15．9±6．7）Svs．（12．3±4．5）S,t=4．304,P=0．000]。2种喉镜声门显露时HR、SBP、MAP变化无统计学差异（P〉0．05）。结论TruviewEVO,喉镜用于颈椎活动受限患者气管插管效果明显优于Macintosh喉镜,可提高气管插管成功率,对于部分困难气道患者具有较好的应用价值。     

可视喉镜与普通喉镜在困难气道插管中的应用价值比较

目的比较可视喉镜与普通喉镜在困难气道插管中的应用价值。方法回顾性分析2018-01—2019-12间宝丰县中医院急诊科收治的104例需行紧急插管的困难气道插管患者的临床资料。按不同喉镜分为普通喉镜组和可视喉镜组,各52例。比较2组喉镜检查分级、一次性插管成功率、声门显露时间、插管次数、插管时间及平均动脉压(MAP)。结果可视喉镜组喉镜检查分级、一次性插管成功率、声门显露时间、插管次数、插管时间,以及声门显露时、置入导管时和导管置入5 min后的MAP等指标,均优于普通喉镜组,差异有统计学意义(P0.05)。结论可视喉镜应用于困难气道插管患者,具有喉镜检查分级优、一次性成功率高、插管次数少、插管时间短,而且对患者的MAP影响较小等优势。     

HC视频喉镜联合纤支镜引导双腔气管插管的临床应用性研究

目的评估HC视频喉镜联合纤支镜用于双腔支气管(DLT)插管的临床效果及其安全性。方法选择ASAⅠ或Ⅱ级择期需DLT插管后行胸科手术的患者80例。随机分为两组(n=40):视频喉镜组(A组)和直接喉镜组(B组)。A组选用HC视频喉镜行DLT插管到声门下,之后用纤支镜引导行支气管插管。B组选用直接喉镜行DLT支气管插管,然后用纤支镜定位。记录声门显露情况、声门显露时间、声门显露后DLT至声门下时间、支气管插管一次成功率、气道损伤情况。结果与B组相比,A组声门一次性显露成功率增高,声门显露时间和声门显露后DLT至声门下时间缩短,环状软骨按压率降低,支气管插管一次成功率升高,气道损伤减少(P<0.05)。结论 HC视频喉镜联合纤支镜引导DLT插管难度降低,患者不良反应减少,可以安全地应用于DLT插管。     

新型Airtraq喉镜（氧瞬得）在困难气管插管中的应用

目的：观察Airtraq喉镜在困难气道插管中的临床应用。方法将60例困难气管插管患者作为研究对象,观察使用Airtraq喉镜插管过程中患者声门显露率、气管插管总成功率和一次插管成功率、插管操作时间、插管操作相关并发症等。结果Airtraq喉镜组患者声门显露均为Ⅰ级,气管插管均一次成功（100％）,插管过程中患者心率和血压稳定,未出现声音嘶哑、牙齿损伤或松动的病例,插管后出现口腔粘膜出血1例,术后咽喉痛1例,分别占总例数的3．3％。结论Airtraq喉镜对麻醉中困难气管插管理及临床抢救插管有较高的应用价值。     

可视插管设备的临床应用现状

正直接喉镜到目前为止仍然是最常用的气管插管方法[1]。可视插管设备能够改善声门显露的Cormack-Lehane分级,并提高整体插管成功率,在气道管理中已经变得越来越重要。与直接喉镜比较,使用可视插管设备能够间接地观察声门,而无需将口腔,咽部和喉部3条轴线对合成1条直线。但更好的声门视图并不意味着容易或成功的气管插管,气管导管的放置有时可能失败[1]。目前,已经开发出     

观察3种不同视频喉镜在模拟困难气道模型气管插管的效果

目的 初次应用3种不同视频喉镜于模拟困难气道模型气管插管时的效果,为临床初次处理困难气道时提供技术数据参考。方法 选择在麻醉科实习1～3个月的实习学生32名,均在调整好的AirSim模拟困难气道模型上使用Macintosh喉镜（M组）,GlideScope(G组)、Hc(H组)和Airtraq(A组)进行气管插管。记录气管插管总时间、获得最佳视野的时间、气管导管置入的时间、气管导管置入次数、喉部暴露分级,同时使用VAS评分评估每种喉镜最佳暴露时使用力量的大小和评价潜在创伤。结果 气管插管总时间最短的是M组。获得最佳视野的时间最短的是M组。气管导管置入时间最短的是M组;声门暴露C/LⅢ级以上,M组、G组、H组和A组暴露情况分别为46.9%、6.2%、9.3%、12.4%。反复置管次数最少的是H组。最佳暴露时A组声门最佳暴露时使用力量最小。结论 对未使用过视频喉镜的志愿者来说,初次应用3种视频喉镜在模拟困难气道模型气管插管时,与Macintosh喉镜相比,3种视频喉镜能明显改善模拟困难气道下的喉部暴露分级,但会延长插管的时间,对急救是不利的。     

Glidescope视频喉镜辅助纤维支气管镜用于老年患者经口气管插管的效果

目的 评价Glidescope视频喉镜辅助纤维支气管镜(FOB)用于老年患者经口气管插管的效果.方法 择期行腹部手术的老年患者40例,年龄65～77岁,体重43 ～ 82 kg,ASA分级Ⅰ级或Ⅱ级,Mallampatis分级l或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):FOB组和Glide -scope组.麻醉诱导后,行气管插管.记录气管插管时间、气管插管成功情况;记录气管插管期间低氧血症的发生情况、Glidescope视频喉镜对声门及会厌的显露情况.结果 与FOB组比较,Glidescope组气管插管时间缩短,1次插管成功率升高(P＜0.05).Glidescope视频喉镜显露声门或显露部分声门15例(75％),仅显露会厌或部分会厌5例(25％).两组气管插管期间均未见低氧血症发生.结论 Glideseope视频喉镜辅助FOB引导经口气管插管时可缩短插管时间,提高首次插管成功概率,可安全有效地用于老年患者.     

Discoscope内窥镜与GlideScope可视喉镜用于声门显露困难患者气管插管效果的比较

目的 比较Discoscope内窥镜与GlideScope可视喉镜用于声门显露困难患者气管插管的效果.方法 择期行经口气管插管的全麻患者40例,Macintosh喉镜显露Cormach-Lehane分级Ⅲ或Ⅳ级,性别不限,年龄24 ～ 78岁,采用随机数字表法,将患者随机分为2组(n=20):GlideScope可视喉镜组(G组)和Discoscope内窥镜组(D组).记录声门显露情况、声门显露时间、气管插管情况、声门显露后至气管导管置入时间和气管插管时间.术后随访患者,记录咽喉出血和咽喉疼痛的发生情况.结果 与G组比较,D组声门显露时间延长,环状软骨按压率降低,声门显露至气管导管置入时间缩短,1次气管插管成功率升高(P＜0.05),1次声门显露成功率、2次声门显露成功率、2次气管插管成功率、气管插管时间、咽喉出血发生率和咽喉疼痛发生率差异无统计学意义(P＞0.05).结论 与GlideScope可视喉镜比较,Discoscope内窥镜用于声门显露困难患者有助于声门的显露,且可提高气管插管的成功机率.     

视频喉镜在垂体瘤患者气管插管中的应用

目的探讨视频喉镜在垂体瘤患者气管插管中的应用。方法选择择期行全麻垂体瘤手术患者51例,男19例,女32例,年龄18~71岁,ASAⅠ或Ⅱ级。随机将患者分为Macintosh喉镜组(M组,n=25)和视频喉镜组(VL组,n=26)。M组患者气管插管时使用Macintosh喉镜暴露声门,VL组患者使用电子视频喉镜暴露声门。测量患者颈部后仰度、张口度、甲颏距、颈围、下颌支长度、改良Mallampati分级及面罩通气难易程度。记录暴露声门时按压环状软骨的比例、Cormack-Lehane分级、二次插管的比例和插管时间。结果VL组按压环状软骨的比例(7.7%vs48.0%)及Cormack-Lehane分级明显低于M组(P0.01),插管时间明显短于M组[(32.4±11.7)s vs(45.8±12.6)s](P0.01)。结论视频喉镜用于垂体瘤患者气管插管,可显著改善声门暴露,提高插管成功率并缩短插管时间。     

Laryngeal mask airway guided fibreoptic tracheal intubation in a child with a lingual thyroglossal duct cyst

The establishment of a tracheal airway with direct laryngoscopy can either be difficult or impossible in children with airway pathology. Multiple direct laryngoscopic attempts cause oedema and/or bleeding with subsequent difficult ventilation. The techniques utilizing the laryngeal mask airway (LMATM) and the fibreoptic bronchoscope have been reported. The case of a child with lingual thyroglossal duct cyst in which the LMA was useful to secure the airway and as a conduit for fibreoptic tracheal intubation is reported.     

Fiberoptic techniques

Fiberoptic intubation of the spontaneously breathing patient is the gold standard and technique of choice for the elective management of a difficult airway. In the hands of the properly trained and experienced user, it is also an excellent 'plan B' alternative when direct laryngoscopy unexpectedly fails. Fiberscope-assisted intubation through an endoscopy face mask, laryngeal mask airway or intubating laryngeal mask airway secures ventilation and oxygenation, and permits endotracheal intubation in airway emergency situations. Portable fiberscopes can be used in remote settings, increasing patient safety. This review discusses current fiberoptic intubation techniques and their applications in the management of both the anticipated and unanticipated difficult airway.     

改良普通喉罩辅助纤维支气管镜气管插管在困难气道患者中的应用

目的观察改良普通喉罩辅助纤维支气管镜(fiberoptic bronchoscope,FOB)气管插管在困难气道患者中的应用效果。方法选择经熟练麻醉医师使用直接喉镜插管2次失败的择期全麻手术患者40例,男21例,女19例,年龄30~55岁,ASAⅠ或Ⅱ级,随机分为两组,每组20例。研究组(LMA-FOB组)将普通喉罩进行改良(剪开喉罩出口栅栏分隔处,剪短通气管),辅助FOB气管插管;对照组(FOB组)经口垫直接使用FOB气管插管。观察咽部解剖结构显露分级,记录一次插管成功率及插管时间,记录拔除喉罩带血和术后咽喉部疼痛、声音嘶哑等不良反应的发生情况。结果与FOB组比较,LMA-FOB组咽部解剖结构显露分级明显提高(Ⅰ/Ⅱ/Ⅲ/Ⅳ级:15/4/1/0vs.8/4/5/3,P0.05),一次插管成功率明显提高(90%vs.60%,P0.05),插管时间明显缩短[(75±20)s vs.(105±25)s,P0.05)]。术后LMA-FOB组仅1例喉罩带血,1例咽部轻微疼痛。结论对可能存在困难气道的患者,采用改良普通喉罩辅助纤维支气管镜引导气管插管可明显提高咽部解剖结构显露分级,提高一次插管成功率,缩短插管时间,术后无明显不良反应,是一种比较安全有效的方法,有一定的临床应用价值。     

Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway

BACKGROUND: Induction of anesthesia and tracheal intubation in small children with a difficult airway is a challenging task. We report the experience with a procedure based on sevoflurane inhalation via a nasopharyngeal airway inserted early during induction before airway obstruction occurs. A pediatric fiberscope is used to perform a nasotracheal intubation via the opposite nostril. METHODS: All small children with suspected or known difficult airway needing tracheal intubation were scheduled for a fiberoptic intubation following the described protocol. RESULTS: In 3 years, we performed 27 successful fiberoptic guided tracheal intubations in 19 children, median age 8.2 months (1.0-39.1 months) and median weight 7.6 kg (3.0-15.0 kg). The optimal depth for placement of the nasopharyngeal airway was found to be 8.0 cm (7.0-8.5 cm) from the nostril in the first year of life and 8.5 cm (8.0-10 cm) in the second year. Oxygenation was sufficient during the entire procedure in all cases except one child who had short-lasting laryngeal spasm caused by instillation of lidocaine during light anesthesia. The duration of fiberoptic intubation was significantly shorter when performed by an experienced anesthesiologist (55 s vs. 120 s), but there was no significant correlation between the duration of fiberoscopy and oxygen saturation during fiberoscopy or endtidal CO(2) after intubation. CONCLUSION: The combination of nasopharyngeal airway and fiberoptic guided tracheal intubation seems to be a reliable and safe procedure for managing the difficult airway in small children.     

A United Kingdom national obstetric intubation equipment survey

BackgroundFailed intubation is relatively common in the obstetric patient. Overall, there has been a decline in experience of general anaesthesia in obstetrics. The level of anaesthetic preparedness in the event of a difficult obstetric intubation is unknown.MethodsWith approval from the Obstetric Anaesthetists’ Association, a national postal survey of obstetric units in the United Kingdom was conducted. The survey addressed airway equipment availability and existence of difficult airway algorithms and formal difficult airway drills. The number of deliveries, general anaesthetic cases and failed intubations in each unit was also ascertained.ResultsOne hundred and eighty-seven units completed the national obstetric intubation equipment survey questionnaire (78% response rate). All obstetric units possessed a laryngoscope with a normal handle and adult Macintosh blade, a bougie and a laryngeal mask airway. A 7.0 internal diameter endotracheal tube was most often used for securing the airway, and 90% of units stored all airway equipment on a designated difficult airway trolley. A fiberoptic bronchoscope was not readily available and on average it would take >10 min to obtain. A failed intubation incidence of 1:309 was reported. Only one third of units promoted difficult airway training.ConclusionEssential airway equipment was readily available in the event of a difficult obstetric intubation, with the exception of a fiberoptic bronchoscope. Few units conduct difficult airway training.     

声门上通气装置引导气管插管的临床应用进展

声门上通气装置（SAD）在院前急救、常规麻醉及困难气道的开放、维持氧合等方面发挥着重要作用,同时也为引导气管插管提供了一个可行方式。在日常麻醉及手术室外治疗或抢救中,保持气道通畅和充分氧合是气道管理的关键。困难插管发生率约4.5%～7.5%,困难气道管理仍是麻醉管理中的重中之重。在困难插管发生时,先可放置SAD,后经SAD盲探或在可视设备辅助下行气管插管,迅速建立气道、提高首次插管成功率、减少插管过程中气道损伤。本文着重介绍不同种类可引导气管插管的SAD的临床应用进展。     

The ''dedicated airway'': a review of the concept and an update of current practice

The term 'dedicated airway' was first used in connection with nasal fibreoptic intubations using the cuffed nasopharyngeal airway. Since that time, the concept has developed and the term has been extended to include fibreoptic intubation techniques involving both the laryngeal mask airway and cuffed oropharyngeal airway. 'Dedicated airway' can now be defined as: 'An upper airway device dedicated to the maintenance of airway patency while other major airway interventions are anticipated or are in progress. The device should be compatible with spontaneous and controlled ventilation. 'Dedicated airway techniques allow planned fibreoptic intubations in difficult cases and provide an emergency airway option in an unexpected difficult intubation when the alternative may be to wake the patient. As well as promoting safe conditions for training fibreoptic intubation in general, there is the particular advantage of being able to train using these techniques in patients known to be difficult to intubate. The authors' evolved clinical experiences in promoting the concept and the relevant literature are reviewed.     

Use of a tracheoscopic ventilation tube for endotracheal intubation in the difficult airway

Difficult endotracheal intubation is a clinical challenge for anesthesiologists and other practitioners of airway management. The use of a tracheoscopic ventilation tube, a novel airway device, for endotracheal intubation during general anesthesia in two patients with difficult airways after unsuccessful direct laryngoscopy is presented.     

A multicentre randomised controlled trial of the McGrath™ Mac videolaryngoscope versus conventional laryngoscopy

Before completion of this study, there was insufficient evidence demonstrating the superiority of videolaryngoscopy compared with direct laryngoscopy for elective tracheal intubation. We hypothesised that using videolaryngoscopy for routine tracheal intubation would result in higher first-pass tracheal intubation success compared with direct laryngoscopy. In this multicentre randomised trial, 2092 adult patients without predicted difficult airway requiring tracheal intubation for elective surgery were allocated randomly to either videolaryngoscopy with a Macintosh blade (McGrath™) or direct laryngoscopy. First-pass tracheal intubation success was higher with the McGrath (987/1053, 94%), compared with direct laryngoscopy (848/1039, 82%); absolute risk reduction (95%CI) was 12.1% (10.9–13.6%). This resulted in a relative risk (95%CI) of unsuccessful tracheal intubation at first attempt of 0.34 (0.26–0.45; p < 0.001) for McGrath compared with direct laryngoscopy. Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (84/1039, 8%) compared with McGrath (8/1053, 0.7%; p < 0.001) No significant difference in tracheal intubation-associated adverse events was observed between groups. This study demonstrates that using McGrath videolaryngoscopy compared with direct laryngoscopy improves first-pass tracheal intubation success in patients having elective surgery. Practitioners may consider using this device as first choice for tracheal intubation.