GlideScope-assisted fiberoptic bronchoscope intubation in a patient with severe rheumatoid arthritis

Here, we report that, under the assistance of both the GlideScope and a fiberoptic bronchoscope, tracheal intubation was accomplished successfully in a 50-year-old woman with severe rheumatoid arthritis who underwent tongue lump resection under general anesthesia. Either the GlideScope or the fiberoptic bronchoscope alone failed to secure the airway; the use of both in combination facilitated airway intubation. This case report indicate that, even with careful preoperative assessment, patients who suffer from rheumatoid arthritis may have severe airway difficulty with intubation, and the combined use of the GlideScope and a fiberoptic bronchoscope can be a novel alternative for tracheal intubation in patients with severe airway difficulty.     

Videolaryngoscopy with Glidescope Reduces Cervical Spine Movement in Patients with Unsecured Cervical Spine

Background

Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided.

Study Objectives

We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines.

Methods

Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope^®, Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle α was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests.

Results

The deviation of α was a median 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p = 0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (α = 10.3°) compared to inexperienced physicians (12.8°, p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy.

Conclusion

GlideScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma.     

视频喉镜辅助胃癌患者术中置入鼻肠管的效果观察

目的 探讨视频喉镜辅助胃癌患者术中置入鼻肠管的应用效果。方法 选取2017年3-9月在我院行根治性全胃切除术的80例患者,按随机数字表将入选患者分为对照组和观察组,每组各40例。对照组采用传统的经鼻盲探下置入鼻肠管,观察组采用视频喉镜辅助鼻肠管置入方法。比较2组患者置管时间、一次置管成功率、鼻腔出血发生率及术后当天咽喉疼痛程度。结果 2组患者鼻肠管的置管时间比较差异无统计学意义（P>0.05）;观察组患者鼻肠管的一次置管成功率高于对照组,鼻腔出血发生率、术后当天咽喉疼痛程度低于对照组（均P<0.05）。结论 胃癌患者术中置入鼻肠管采用视频喉镜辅助,可提高一次置管成功率,降低鼻腔出血发生,减轻咽喉疼痛程度。     

急诊抢救中应用GlideScope视频喉镜气管插管的临床体会

目的观察GlideScope视频喉镜在急诊抢救中的应用效果,总结气管插管体会。方法 32例运用GlideScope视频喉镜经口气管插管的急诊患者,分别记录每个患者插管时间、插管次数、一次插管成功率、一次成功插管时间以及插管所致的即时并发症,并与普通喉镜经口气管插管的急诊患者作对比。结果两组病例的一般情况比较差异无统计学意义。视频喉镜组一次成功插管时间、一次插管成功率较普通喉镜组有明显差异(P<0.05),视频喉镜组的插管时间、插管次数与普通喉镜组均存在显著性差异(P<0.01),视频喉镜组即时并发症显著低于普通喉镜组(P<0.01)。结论采用GlideScope视频喉镜一次插管成功率高、速度快、并发症少,在急诊抢救中具有极高的临床价值。同时,充分开放气道、左手持械时灵活调节视频喉镜角度和进度有助于提高一次插管成功率,减少并发症。     

GlideScope视频喉镜和Macintosh直接喉镜在颈椎制动患者气管插管中的比较

 目的 比较GlideScope视频喉镜和Macintosh直接喉镜在颈椎制动患者气管插管中的难易,及两种工具插管对血液动力学的影响。方法 拟在经口气管插管全身麻醉下行择期手术的患者60例,ASAⅠ级,年龄18～60岁,随机分为G组和M组（n=30）。常规麻醉诱导后,手法制动头颈部,G组采用GlideScope视频喉镜,M组用Macintosh直接喉镜行气管插管。分析比较两组声门暴露情况（Cormark-Lehane分级）以及暴露时间,试插次数,失败例数,有无助手辅助,插管前后心率与收缩压乘积（rate-pressure product,,RPP）变化。结果 与M组比较,G组声门暴露情况较好,但暴露时间显著延长（P＜0.05）。M组需要助手辅助及插管失败的比例均高于G组。两组RPP的变化在各个时点无显著差别。结论 在为颈椎制动患者气管插管中,GlideScope视频喉镜能够更好的显露声门,降低插管难度,提高插管的成功率。     

视频喉镜和头部可控气管导管用于困难气道经口气管插管的临床研究

目的:评价在视频喉镜下使用头部可控气管导管在困难气道经口气管插管中的应用,观察其可操作性和临床应用价值。方法:术前评估为困难气道择期外科手术患者33例,ASAⅠ或Ⅱ级,随机分为3组:M组、G1组和G2组,每组各11例,常规麻醉诱导后,M组用Macintosh直接喉镜和普通气管导管,G1组采用Glidescope视频喉镜和普通气管导管,G2组采用Glidescope视频喉镜和头部可控气管导管,实施经口气管插管。分别记录采用Macintosh直接喉镜和Glidescope视频喉镜喉部显露Cormark-Lehane分级、气管插管操作时间和插管成功率和一次成功率。结果:与M组相比,G1组和G2组Cormark-Lehane分级中Ⅰ和Ⅱ级的例数显著增多(P<0.05);G1组和G2组插管时间明显缩短(P<0.05),其中G2组插管时间明显缩短于G1组(P<0.05);G1组和G2组插管成功率显著增加(P<0.05),插管一次成功率G2组明显高于G1组(P<0.05)。结论:采用Glidescope视频喉镜实施经口气管插管具有喉部显露清晰、损伤小和降低气管插管难度等优点,配合使用头部可控导管使操作更容易。     

GlideScope可视喉镜在院前急救中的应用

院前急救是危重症患者抢救的首要环节,也是急诊体系最前沿的阵地。在院前急救中,气管插管是保证呼吸道通畅、维持供氧必不可少的手段。可视化技术的发展为急救医学提供了新的呼吸道建立模式,为麻醉学和急救医学开启了新篇章。我们采用GlideScope可视喉镜气管插管,对比研究Truphatek普通喉镜气管插管,旨在探讨院前急救中快速有效的气管插管方式。     

GlideScope视频喉镜与光导纤维支气管镜经口气管插管对血流动力学影响的比较

目的比较全身麻醉诱导后采用GlideScope视频喉镜(GSVL)和光导纤维支气管镜(FOB)经口气管插管对血流动力学的影响。方法施择期整形外科手术患者57例,随机分为GSVL组(n=29)和FOB组(n=28)。在常规静脉麻醉诱导后实施气管插管操作。监测麻醉诱导前、后,气管插管时和气管插管后1、2、3、4、5min的血压和心率变化。结果GSVL组与FOB组气管插管时间差异无显著性(P>0·05)。气管插管后两组患者的血压和心率均比麻醉诱导后明显升高,但血压最大值未超过麻醉诱导前水平,而心率最大值较麻醉诱导前显著升高。两组在观察期各对应时间点的血压和心率及血压和心率最大值差异均无显著性(P>0·05)。结论GSVL经口气管插管可引起与FOB经口气管插管相同程度的心血管系统应激反应。     

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision® videolaryngoscope

Airway management in patients with periglottic tumour is a high‐risk procedure with potentially serious consequences. There is no consensus on how best to secure the airway in this group of patients. We conducted a feasibility study of awake tracheal intubation using a King Vision^® videolaryngoscope with a channelled blade in a cohort of 25 patients, with a periglottic tumour requiring diagnostic or radical surgery. We used 10% and 4% lidocaine to topicalise the airway and midazolam and remifentanil for sedation. We recorded the success rate, number of attempts, time to obtain glottic view, time to intubation and complications. Twenty‐three of the 25 patients (92%, 95%CI 75–98%) were intubated with the awake videolaryngoscope‐assisted technique, with 17/23 (74%, 95%CI 54–87%) intubations achieved at the first attempt. Five patients required two and one patient, three attempts at intubation. Two patients (8%, 95%CI 2–25%) could not tolerate the procedure due to inadequate topical anaesthesia. Median (IQR [range]) times to obtain glottic view and to intubate were 19 (17–22 [10–30]) s and 49 (42–71 [33–107]) s, respectively. Traces of blood in the airway were observed in 4/25 (16%, 95%CI 6–35%) patients. Although airway management in this group of patients was expected to be difficult, successful awake intubation with the King Vision videolaryngoscope was achieved in the majority of patients within less than a minute. This study highlights a number of potential advantages of awake videolaryngoscope‐assisted intubation over other awake methods of securing the airway in patients with upper airway obstruction due to periglottic mass.     

GlideScope视频喉镜在评估困难气道中的应用

目的应用GlideScope视频喉镜对术前预计为困难气道的患者进行评估,探讨其应用价值。方法 30例术前评估为困难气道的患者,先在半清醒状态下分别应用Macintosh直接喉镜和GlideScope视频喉镜进行气道评估,记录喉部显露分级和暴露声门即刻血流动力学指标。若Cormack and Lehane分级评估在Ⅱ级以下,即在快诱导下行气管插管;Ⅱ级以上,则按照ASA困难气道处理方案执行。结果 GlideScope视频喉镜可显著降低Cormackand Lehane分级,与Macintosh直接喉镜相比其显露声门时所致的血流动力学波动更小。结论应用Glide Scope视频喉镜能够更直观精准的对困难气道进行评估,有利于选择适当的麻醉诱导方法,增加此类患者在插管时的安全系数、舒适度及避免不必要的血流动力学波动。