GlideScope视频喉镜在抢救气管插管中的应用价值

目的探讨GlideScope视频喉镜在抢救气管插管中的应用价值。方法随机将2012年1～12月由本科行抢救气管插管的159例患者分为GlideScope视频喉镜组（A组,n=80例）和普通喉镜组（B组,n=79例）,记录患者的插管时间、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刻并发症,采用t检验及χ2检验对两组数据行统计分析。结果 A组一次成功插管时间、一次插管成功率与B组比较,差异有统计学意义（P〈0.05）,A组的插管时间、插管次数与B组比较,差异有统计学意义（P〈0.01）,A组即刻并发症显著低于B组,差异有统计学意义（P〈0.01）。结论 GlideScope视频喉镜一次插管成功率高、速度快、并发症少,在抢救气管插管中具有较高的应用价值。     

Alternative techniques for tracheal intubation

Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficult situations. Awake fibreoptic intubation (AFOI) remains the ‘gold standard’ method for securing the airway in an anticipated difficult intubation. Advances in optical technology over recent years have lead to the development of several rigid indirect devices, which improve glottic visualization by enabling the operator to ‘see around the corner’. With improved views at laryngoscopy these videolaryngoscopes are emerging as important tools in airway management and useful teaching and training aids.     

Videolaryngoscopy vs. Macintosh laryngoscopy for double‐lumen tube intubation in thoracic surgery: a systematic review and meta‐analysis

Double‐lumen intubation is more difficult than single‐lumen tracheal intubation. Videolaryngoscopes have many advantages in airway management. However, the advantages of videolaryngoscopy for intubation with a double‐lumen tube remain controversial compared with traditional Macintosh laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library and the Web of Science for randomised controlled trials comparing videolaryngoscopy with Macintosh laryngoscopy for double‐lumen tube intubation. We found that videolaryngoscopy provided a higher success rate at first attempt for double‐lumen tube intubation, with an odds ratio (95%CI) of 2.77 (1.92–4.00) (12 studies, 1215 patients, moderate‐quality evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or dental injuries during double‐lumen tube intubation, odds ratio (95%CI) 0.36 (0.15–0.85) (11 studies, 1145 patients, low‐quality evidence, p = 0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54 (0.36–0.81) (7 studies, 561 patients, moderate‐quality evidence, p = 0.003), compared with Macintosh laryngoscopy. There were no significant differences in intubation time, with a standardised mean difference (95%CI) of ?0.10 (?0.62 to 0.42) (14 studies, 1310 patients, very low‐quality evidence, p = 0.71); and the incidence of postoperative voice change, odds ratio (95%CI) 0.53 (0.21–1.31) (7 studies, 535 patients, low‐quality evidence, p = 0.17). Videolaryngoscopy led to a higher incidence of malpositioned double‐lumen tube, with an odds ratio (95%CI) of 2.23 (1.10–4.52) (six studies, 487 patients, moderate‐quality evidence, p = 0.03).     

Cuff Inflation to Aid Nasotracheal Intubation Using the C-MAC Videolaryngoscope

A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation.     

GlideScope视频喉镜在困难气道患者气管插管中的应用

目的 观察GlideScope视频喉镜对困难气道气管插管患者血流动力学及皮质醇、血糖水平的影响。方法 40例Mallampati分级Ⅲ~Ⅳ级患者,随机分为视频喉镜组和直接喉镜组各20例,视频喉镜组以GlideScope视频喉镜行气管插管,直接喉镜组以Macintosh直接喉镜行气管插管,记录2组麻醉诱导前（T1）、气管插管即刻（T2）、气管插管后1min（T3）平均动脉压、心率,检测各时间点皮质醇及血糖水平,比较2组气管插管时间、首次插管成功率。结果 2组T2、T3时平均动脉压、心率较T1时增高（P〈0.05）,视频喉镜组T2时平均动脉压、心率低于直接喉镜组（P〈0.05）;直接喉镜组T2、T3时皮质醇、血糖水平较T1时增高（P〈0.05）,视频喉镜组T2、T3时皮质醇、血糖较T1时略增高,但差异无统计学意义（P〉0.05）;2组间各时间点皮质醇、血糖水平比较差异无统计学意义（P〉0.05）;视频喉镜组气管插管时间（（1.63±0.62）min）较直接喉镜组（（2.89±0.71）min）短（P〈0.05）,首次插管成功率（90%）高于直接喉镜组（65%）（P〈0.05）。结论 困难气道患者气管插管中应用GlideScope视频喉镜可明显减轻插管时的心血管反应,提高首次插管成功率。     

GlideScope视频喉镜和Macintosh直接喉镜在经鼻气管插管中的比较

目的比较GlideScope视频喉镜和Macintosh直接喉镜在经鼻气管插管中的难易。方法选择在经鼻气管插管全身麻醉下行择期颌面外科手术的患者60例,ASAⅠ～Ⅱ级,年龄18～60岁。随机分为G组（n=30）和M组（n=30）。常规麻醉诱导后,G组采用GlideScope视频喉镜,M组用Macintosh直接喉镜行经鼻气管插管。分析比较两组声门暴露情况（Cormark-Lehane分级）以及插管时间,一次插管成功率,失败例数。结果与M组比较,G组声门暴露情况较好（P〈0.01）,并且气管插管时间明显缩短（P〈0.01）。结论在经鼻气管插管中,GlideScope视频喉镜能够更好地暴露喉部结构,提高Cormark-Lehane分级,降低插管难度。     

Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope

We report a case in which a videolaryngoscope was used to facilitate endotracheal intubation in a patient with a large exophytic mass involving the right supraglottis. After intubation, it was noted that the soft palate had been perforated by the styletted endotracheal tube. The defect closed spontaneously postoperatively within 9 days.     

Videolaryngoscopy vs. flexible fibrescopy for tracheal intubation in patients with cervical spine immobilisation: a randomised controlled trial

In patients with cervical spine immobilisation, tracheal intubation devices other than a direct laryngoscope are frequently used to facilitate tracheal intubation and avoid related complications. In this randomised controlled trial, we compared videolaryngoscopic and fibrescopic tracheal intubation in patients with a cervical collar. Tracheal intubation was performed using either a videolaryngoscope with a non-channelled Macintosh blade (n = 166) or a flexible fibrescope (n = 164) in patients having elective cervical spine surgery whose neck was immobilised with a cervical collar to simulate a difficult airway. The primary outcome was the first attempt success rate of tracheal intubation. Secondary outcomes were the overall success rate of tracheal intubation; time to tracheal intubation; use of additional airway manoeuvres; and incidence and severity of tracheal intubation-related airway complications. First attempt success rate was higher in the videolaryngoscope group than in the fibrescope group (164/166 (98.8%) vs. 149/164 (90.9%), p = 0.003). Tracheal intubation was successful within three attempts in all patients. Median (IQR [range]) time to tracheal intubation was shorter (50.0 (41.0–72.0 [25.0–170.0]) s vs. 81.0 (65.0–107.0 [24.0–178.0]) s, p < 0.001) and additional airway manoeuvres were less frequent (30/166 (18.1%) vs. 91/164 (55.5%), p < 0.001) in the videolaryngoscope group compared with the fibrescope group. The incidence and severity of intubation-related airway complications were not different between the two groups. When performing tracheal intubation in patients with a cervical collar, videolaryngoscopy with a non-channelled Macintosh blade was superior to flexible fibrescopy.     

Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope® videolaryngoscope: a randomised,controlled comparison of three tracheal tubes

Difficulty during placement of the tracheal tube is a known problem when intubating with the GlideScope^®, which may lead to subglottic airway injury. This randomised, controlled clinical trial was designed to compare the resistance to passage of PVC (polyvinyl chloride), reinforced or BlockBuster tracheal tubes during intubation with the GlideScope. Secondary outcomes included the time taken to intubate and assessment of subglottic airway injury. One‐hundred and seventy‐seven patients were included in the data analysis. There was difficult tracheal tube passage (moderate or severe resistance) in 15 (21.4%) patients using the PVC tube compared with 4 (7.4%) and 1 (1.9%) using the reinforced and BlockBuster tubes, respectively (p = 0.003 for PVC vs. BlockBuster). The median (IQR [range]) time taken to intubate was 35 (27–45 [15–115]) s, 25 (20–27 [15–110]) s and 25 (22–30 [16–90]) s, respectively, (p < 0.001 for PVC vs. reinforced as well as PVC vs. BlockBuster). Subglottic airway injury, assessed using a fibreoptic bronchoscope after extubation, was higher with the PVC tube (p < 0.001) and the reinforced tube (p = 0.012) compared with the BlockBuster tube. We conclude that the BlockBuster tracheal tube is a better choice for orotracheal intubation with the GlideScope than PVC or reinforced tubes.     

GlideScope可视喉镜与普通喉镜用于腭裂患儿困难气道的比较研究

目的:比较GlideScope 可视喉镜与普通喉镜用于腭裂困难气道患儿气管插管的效果。方法:选择行择期腭裂修复术患儿60例,ASA分级Ⅰ~Ⅱ级,性别不限,年龄8个月~3岁,体重5～15 kg,Mallampati分级Ⅲ级及以上,随机分为两组,普通喉镜组(A组)和GlideScope 可视喉镜组(B组)。麻醉诱导后分别用普通喉镜和GlideScope 可视喉镜引导经口气管插管。记录两组患者气管插管时间(从喉镜置入到退出时间)、气管插管成功率、环状软骨按压例数、Cormark-Lehane分级(用于计算声门暴露满意率);有无插管操作相关的口咽软组织损伤。结果:与A组比较,B组声门暴露满意率明显提高,需要甲状软骨按压辅助气管插管例数显著减少,气管插管成功率显著提高(P<0.05)。两组患者气管插管时间和气管插管损伤差异无统计学意义。结论:GlideScope可视喉镜用于困难气道气管插管的效果要优于普通喉镜。