Standard clinical risk factors for difficult laryngoscopy are not independent predictors of intubation success with the GlideScope

Study Objectives

To determine whether the first-attempt tracheal intubation incidence using the GlideScope videolaryngoscope is higher in patients with predicted increased risk of difficult laryngoscopy, and to assess the ability of other a priori defined standard risk factors to predict first-attempt intubation success, in aggregate and by forming scores.

Design

Prospective study.

Setting

Operating room in a tertiary-care academic center.

Patients

357 patients intubated with the GlideScope for nonemergent general anesthesia.

Interventions and Measurements

Mallampati airway class was used to create two groups of patients, one with higher and the other, lower, potential difficult laryngoscopy (Mallampati classes 3-4 and 1-2, respectively). Intubation success on the first attempt with the GlideScope videolaryngoscope in patients with a Mallampati class 3 or 4 airway versus those with Mallampati class 1 or 2 airway was tested. We also evaluated the predictive ability of the Mallampati airway class (1 and 2 vs 3 and 4) along with 9 other possible predictors of difficult intubation on first-attempt intubation success: gender, age, body mass index, level of training within our anesthesia residency program (Clinical Anesthesia Resident years 1, 2, and 3), ASA physical status, mouth opening, thyromental distance, neck flexion, and neck extension.

Main Results

None of the standard predictors of difficult intubation was significantly associated with outcome after adjusting for other predictors. A multivariable model containing the aggregate set of variables predicted outcome significantly better than a risk score formed as the sum of 10 predictors (“Risk 10”; P = 0.0176).

Conclusions

With GlideScope-assisted tracheal intubation, Mallampati airway class is not an independent risk factor for difficult intubation. Other standard clinical risk factors of difficulty with direct laryngoscopy also do not appear to be individually predictive of first-attempt success of tracheal intubation.     

Evaluation of the Bullard, GlideScope, Viewmax, and Macintosh laryngoscopes using a cadaver model to simulate the difficult airway

Study Objective

To assess the performance and cervical (C)-spine movement associated with laryngoscopy using the Bullard laryngoscope (BL), GlideScope videolaryngoscope (GVL), Viewmax, and Macintosh laryngoscopes during conditions of a) unrestricted and b) restricted C-spine and temporomandibular joint (TMJ) mobility.

Design

Prospective, controlled, randomized, crossover study.

Setting

University teaching hospital.

Subjects

21 cadavers with intact C-spine anatomy.

Interventions

Each cadaver underwent to total of 8 intubation attempts to complete the intubation protocol using all four devices under unrestricted and restricted C-spine and TMJ mobility.

Measurements

Laryngoscopic view was graded using the modified Cormack-Lehane system. Time to best laryngoscopic view and total time to intubation were recorded. C-spine movement was measured between McGregor's line and each vertebra from radiographs taken at baseline and at best laryngoscopic view.

Main Results

During both intubating conditions, the BL achieved the highest number of modified Cormack-Lehane grade 1 and 2A laryngoscopic views as compared to the other three devices (P < 0.05) and had fewer intubation failures than the Viewmax or Macintosh laryngoscopes (P < 0.05). The GVL had superior laryngoscopic performance as compared to the Viewmax and Macintosh laryngoscopes (P < 0.05) and had fewer intubation failures than those two devices (P < 0.05). All devices except the Macintosh laryngoscope in restricted mobility achieved median times to intubation in less than 30 seconds. For both conditions, BL showed the least total absolute movement between Occiput/C1 and C3/C4 of all the devices (all P < 0.05). Most of the difference was seen at C1/C2.

Conclusions

In cadavers with unrestricted and restricted C-spine mobility, the BL provided superior laryngoscopic views, comparable intubating times, and less C-spine movement than the GVL, Viewmax, or Macintosh laryngoscopes.     

GlideScope视频喉镜在颈椎活动受限患者气管插管中的应用体会

目的 介绍新型插管工具GlideScope视频喉镜在颈椎活动受限患者插管中的应用.方法 84例择期或急诊颈椎手术患者,ASAI～II级,术前存在颈椎外伤或严重的颈椎病,在快速静脉全麻诱导后先用Macintosh喉镜暴露声门进行Comack评级,然后运用视频喉镜进行插管,记录插管操作时间、次数和并发症,并测量诱导前(T_1)、诱导后(T_2)、插管时(T_3)、插管后1min(T_4)、气管插管后3 min(T_5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP).结果 GlideScope视频下Cor-mack分级显著改善(P<0.05),插管成功率为970.6%,插管时间为12 s~135 s,平均为(28.7±9.2)s.78例患者1次插管成功;4例患者2次插管成功;另有2例患者改为纤支镜插管;82例患者在气管插管过程中HR、SBP、DBP、ABP平稳,插管未造成呼吸道损伤.结论 GlideScope视频喉镜插管适合颈椎活动受限的困难气道,成功率高、插管迅速、安全性好.     

双镜联合用于阻塞性睡眠呼吸暂停综合征患者经鼻气管插管的观察*

目的观察纤维支气管镜(FOB)联合Glidescope视频喉镜(GVL)用于阻塞性睡眠呼吸暂停综合征(OSAS)患者经鼻气管插管的效果。方法拟行腭咽成型术的OSAS患者90例,随机分为M、G和F3组,每组30例,M组使用普通喉镜、G组使用GVL、F组使用FOB联合GVL经鼻气管插管,记录麻醉开始前(T_0)、气管插管即刻(T_1)、插管后1 min(T_2)和5 min(T_3)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和气管插管时间,观察喉镜显露Cormack-Lehane(C-L)分级情况及一次插管成功率、按压喉外部和使用气管插管钳的发生率以及鼻腔出血和低氧血症的发生率。结果 C-L分级G和F组优于M组(P 0.05),一次插管成功率M组低于G和F组(P 0.05),需按压喉外部F组低于M和G组(P 0.05),G组低于M组(P 0.05),使用气管插管钳次数和鼻腔出血的发生率F组低于M和G组(P 0.05)。结论 FOB联合GVL用于OSAS患者经鼻气管插管,可提高气管插管成功率,减少鼻腔出血。     

应用视频喉镜和直接喉镜经口气管插管的比较研究

目的比较GlideScope视频喉镜(GSVL)和直接喉镜(DLS)在经口气管插管应用中的优缺点。方法根据美国麻醉医师协会(ASA)身体状况分级为2～3级、年龄l8～65岁,拟在经口气管插管全身麻醉下行择期普外科手术的100例患者随机分为GSVL组和DLS组,每组50例。常规麻醉诱导后,分别采用GSVL或DLS实施经口气管插管操作。观察两组患者气管插管时间及气管插管一次成功率,记录麻醉诱导前、气管插管前即刻、气管插管后即刻及气管插管后1、3min的有创动脉血压(ABP)和心率(HR)变化,观察ABP、HR的最大值和最小值,同时记录两组患者术后咽痛发生情况。结果两组患者的一般情况和气管插管时间差异无统计学意义。GSVL组气管插管一次成功率高于DLS组(P<0.05)。两组气管插管前即刻的ABP较基础值显著降低(P<0.05),但HR无明显改变。与气管插管前相比,气管插管后即刻两组的ABP、HR显著升高(P<0.05)。与麻醉诱导前基础值相比,DLS组观察期MAP、HR的最大值显著升高(P<0.05),但GSVL组气管插管后的各项血流动力学指标与基础值比较差异无统计学意义。DLS组气管插管后即刻的HR高于GSVL组(P<0.05)。GSVL组患者术后咽痛发生率明显低于DLS组(P<0.05)。结论采用GSVL实施气管插管与DLS相比具有成功率高、血流动力学反应轻、术后咽痛发生率小等优点。     

GlideScope视频影像喉镜在胸部恶性肿瘤气管插管中的应用

目的评价GlideScope视频影像喉镜在胸部恶性肿瘤根治术患者双管腔在气管插管中的应用,观察其可操作性和临床应用的价值.方法选择80例择期行胸部恶性肿瘤根治手术的患者,术前评估Mallampti舌咽分级.患者的体位取仰卧位,将带有隆突钩的双腔管缩型为视频镜片相一致的角度(大约60°)从口腔偏右侧进入,显示屏上可显示气管插管的全部过程.同时记录患者暴露的时间、气管插管操作时间、显示器直视下喉部暴露分级.结果本组患者均借助喉GlideScope视频影像喉镜进行双腔管插管,喉部显露为Ⅰ～Ⅱ级,成功率为100%,2例为直接喉镜显露Ⅳ级的患者.从操作开始到满意暴露声门的时间为(24.2±10.32)s;气管插管时间(27.1±23.4)s.结论作为一种新型气管插管工具,视频喉镜为解决临床双腔气管插管问题提供了新的思路,将有望在临床广泛应用.     

Circulatory responses to nasotracheal intubation: comparison of GlideScope® videolaryngoscope and Macintosh direct laryngoscope

Background The GlideScope videolaryngoscope （GSVL） has been shown to have no special advantage over the Macintosh direct laryngoscope （MDL） in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation （NTI） using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL.
Methods Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure （BP） and heart rate （HR） were recorded before induction （baseline values） and immediately before intubation （post-induction values）, at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP （SBP） and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes 〉 30% of baseline values were also noted. The product of HR and systolic BP, i.e. rate pressure product （RPP）, and the areas under SBP and HR vs. time curves （AUGsBP and AUGHR） were calculated.
Results The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUGSBP, maximum values of BP and incidence of SBP percent increase 〉 30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUGHR and incidence of HR percent increase 〉 30% of baseline value were significantly higher in the MDL group than in the GSVL group. Times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group.
Conclusions The pressor     

GlideScope视频喉镜、直接喉镜和光导纤维支气管镜经鼻气管插管时血流动力学反应的比较

目的比较采用GlideScope视频喉镜(GSVL)、Macintosh型直接喉镜(MDLS)和光导纤维支气管镜(FOB)实施经鼻气管插管时的血流动力学反应。方法将美国麻醉医师协会(ASA)身体状况分级为Ⅰ~Ⅱ级、年龄18~50岁、拟在经鼻气管插管全身麻醉下施择期整形外科手术的60例患者随机分为GSVL组、MDLS组和FOB组,每组20例。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经鼻气管插管操作。观察记录麻醉诱导前基础值、麻醉诱导后值,气管插管时和气管插管后5min内每间隔1min的血压(BP)和心率(HR),并记录观察期BP、HR的最大值和最小值,计算各时间点的心率收缩压乘积(RPP)。以时间为横坐标及观察期BP和HR的变化为纵坐标计算气管插管后观察期血流动力学时-效关系曲线下面积(AUE)。结果3组的基本情况和气管插管时间差异无显著性。麻醉诱导后3组的BP和RPP较基础值显著降低(P<0.05),而HR无显著性变化。经鼻气管插管导致3组的BP、HR和RPP较麻醉诱导后值显著升高(P<0.05)。与基础值相比,气管插管时FOB组的BP、HR和RPP均显著升高(P<0.05),MDLS组气管插管时的HR以及观察期舒张压、平均动脉压、HR和RPP的最大值显著升高(P<0.05),但GSVL组气管插管时和气管插管后的各项血流动力学指标与基础值差异均无显著性。FOB组气管插管时的各项血流动力学指标和观察期HR>100bpm的发生率显著高于GSVL组和MDLS组(P<0.05);虽然观察期的BP在MDLS组和GSVL组之间差异无显著性,但MDLS组气管插管时和气管插管后的HR和RPP以及AUEHR显著高于GSVL组(P<0.05)。GSVL组的AUEHR和AUESBP显著低于FOB组(P<0.05)。结论实施经鼻气管插管时的血流动力学反应在采用FOB时最强,MDLS次之,GSVL最轻。     

GlideScope视频喉镜不能减轻经口气管插管的心血管反应

目的：通过与Macintosh直接喉镜相比较．评价GlideScope视频喉镜是否能够减轻经口气管插管的心血管反应。方法：选择60例ASAⅠ-Ⅱ级、年龄18—60岁和拟在经口气管插管全身麻醉下施择期整形外科手术的患者，随机分为GlideScope视频喉镜组（GSVL组，3嘲）和Macintosh直接喉镜组（MDLS组，30例）。麻醉诱导后分别采用GlideScope视频喉镜或Macintosh直接喉镜实施经口气管插管操作，观察麻醉诱导前、后，气管插管时和气管插管后5min内的血压、心率（HR）和二重指数（RPP）的变化，并记录气管插管时间。结果：GSVL组的气管插管时间显著长于MDLS组。麻醉诱导后，两组的血压和RPP均较麻醉诱导前基础值显著降低。与麻醉诱导后值相比，气管插管引起两组的血压、HR和RPP显著升高。除了GSVL组观察期的DBP最大值之外，气管插管在两组引起的血压升高均未显著超过基础值。与基础值相比，GSVL组气管插管时的14R和RPP显著升高，并且HR增快持续了4min；虽然MDLS组气管插管时的HR亦显著高于基础值。但是HR增快仅持续了1min。两组在所有观察时间点的心血管指标均无显著差异。结论：采用GlideScope视频喉镜和Macintosh直接喉镜实施经口气管插管可引起类似的心血管反应。GlideScope喉镜在减轻经口气管插管心血管反应方面并不优于Macintosh直接喉镜。