.: ORİJİNAL ARAŞTIRMA
Is Awake Videolaryngoscopic Assessment of the Airway a New Tool to Predict the Unpredictable?: A Randomised Crossover Clinical Trial
Havayolunun Uyanık Video Laringoskopik Değerlendirmesi Öngörülmeyeni Öngörmekte Yeni Araç Olabilir mi?: Randomize Çapraz Geçişli Çalışma
Turkiye Klinikleri J Anest Reanim. 2021;19(1):1-7
doi: 10.5336/anesthe.2020-78587
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Even with worldwide acceptance and obedience to airway evaluation tests, there have not been enough tests performed to predict a difficult intubation with 100% accuracy. The Cochrane database published a review about the insufficiency of airway examination tests. For decades, anesthesiologists have tried to identify these issues. Material and Methods: After ethics committee approval and written informed consent had been obtained, 20 patients were enrolled to this prospective randomised study. All patients were oxygenated before and during the procedure. Standard anesthesia monitoring and 0.05 mg.kg-1 midazolam was administered intravenously. The nasopharynx was prepared with a topical 10% lidocaine spray then a continuous remifentanil infusion was given at a rate of 0.07 μ.kg.min-1 at least for 3 minutes. Awake videolaryngoscopy with Storz C-MAC, Storz D-Blade, McGrath MAC X-Blade and Airtraq was performed in random order to the same patient. Results: Two women denied participation and we analysed 18 patients. One patient did not allow the Airtraq to be inserted deeper and so we had 17 analyses for awake assessment for the Airtraq. Demographic and airway variables of patients were similar. The duration to obtain the optimal view was similar among the videolaryngoscopes. The comfort rating of patient and the observer were lower in the C-MAC (p<0.001). The Cormack-Lehane grades were worse in the C-MAC when compared to the others (p=0.006). Gag reflex occurred more in the Airtraq and the C-MAC videolaryngoscopes (p=0.007). Conclusion: Airtraq, McGrath MAC X-Blade, Storz D-Blade was superior to Storz C-MAC for awake videolaryngoscopic assessment of the airway as a new tool to predict a difficult laryngoscopy.
Keywords: Laryngoscopes; intubation; airway management
Objective: Even with worldwide acceptance and obedience to airway evaluation tests, there have not been enough tests performed to predict a difficult intubation with 100% accuracy. The Cochrane database published a review about the insufficiency of airway examination tests. For decades, anesthesiologists have tried to identify these issues. Material and Methods: After ethics committee approval and written informed consent had been obtained, 20 patients were enrolled to this prospective randomised study. All patients were oxygenated before and during the procedure. Standard anesthesia monitoring and 0.05 mg.kg-1 midazolam was administered intravenously. The nasopharynx was prepared with a topical 10% lidocaine spray then a continuous remifentanil infusion was given at a rate of 0.07 μ.kg.min-1 at least for 3 minutes. Awake videolaryngoscopy with Storz C-MAC, Storz D-Blade, McGrath MAC X-Blade and Airtraq was performed in random order to the same patient. Results: Two women denied participation and we analysed 18 patients. One patient did not allow the Airtraq to be inserted deeper and so we had 17 analyses for awake assessment for the Airtraq. Demographic and airway variables of patients were similar. The duration to obtain the optimal view was similar among the videolaryngoscopes. The comfort rating of patient and the observer were lower in the C-MAC (p<0.001). The Cormack-Lehane grades were worse in the C-MAC when compared to the others (p=0.006). Gag reflex occurred more in the Airtraq and the C-MAC videolaryngoscopes (p=0.007). Conclusion: Airtraq, McGrath MAC X-Blade, Storz D-Blade was superior to Storz C-MAC for awake videolaryngoscopic assessment of the airway as a new tool to predict a difficult laryngoscopy.
Keywords: Laryngoscopes; intubation; airway management
ÖZET
Amaç: Havayolu değerlendirme testleri tüm dünyaca kabul edilmiş ve itaat edilmiş olunmasına rağmen zor havayolunu %100 öngörebilecek yeterli test bulunmamaktadır. Cochrane veri tabanı, havayolu değerlendirme testlerinin yetersizliği ile ilgili derleme yayımlamıştır. Dekatlardan beri anestezistler, bu konuları tanımlamaya çalışmıştır. Gereç ve Yöntemler: Yazılı bilgilendirilmiş hasta onamı ve etik kurul onamı alındıktan sonra bu prospektif randomize çalışmaya 20 hasta dâhil edildi. Tüm hastalar işlem öncesi ve sonrasında oksijene edildi. Standart anestezi monitörizasyonu ve 0,05 mg.kg-1 midazolam intravenöz olarak uygulandı. Nazofarinks, %10 topikal lidokain sprey ile hazırlandıktan sonra en az 3 dk boyunca 0,07 μgr.kg.dk-1 hızda sürekli remifentanil infüzyonu verildi. Storz C-MAC, Storz D-Blade, McGrath MAC X-Blade ve Airtraq ile uyanık video laringoskopi rastgele aynı hastaya uygulandı. Bulgular: İki kadın hasta katılmayı reddetti ve 18 hasta analiz edildi. Bir hasta Airtraq'in derine yerleştirilmesine izin vermedi, böylece uyanık değerlendirmede Airtraq için 17 hasta analizimiz oldu. Hastaların demografik ve havayolu verileri benzerdi. Optimal görüntüyü elde etme zamanı gruplar arasında benzerdi. Hastanın ve gözlemcinin konfor derecelendirmesi C-MAC'de düşüktü (p<0,001). Cormack-Lehane evreleri C-MAC'de diğerlerine kıyasla kötüydü (p=0,006). Krikoid bası ile Cormack-Lehane evreleri video laringoskoplar arasında benzerdi. Airtraq ve C-MAC video laringoskoplarında daha fazla öğürme refleksi gelişti (p=0,007). Sonuç: Zor laringoskopinin öngörülmesinde yeni araç olarak, Airtraq, McGrath MAC X-Blade ve Storz D-Blade, uyanık video laringoskopik değerlendirmede Storz C-MAC'den üstündür.
Anahtar Kelimeler: Laringoskoplar; entübasyon; havayolu yönetimi
Amaç: Havayolu değerlendirme testleri tüm dünyaca kabul edilmiş ve itaat edilmiş olunmasına rağmen zor havayolunu %100 öngörebilecek yeterli test bulunmamaktadır. Cochrane veri tabanı, havayolu değerlendirme testlerinin yetersizliği ile ilgili derleme yayımlamıştır. Dekatlardan beri anestezistler, bu konuları tanımlamaya çalışmıştır. Gereç ve Yöntemler: Yazılı bilgilendirilmiş hasta onamı ve etik kurul onamı alındıktan sonra bu prospektif randomize çalışmaya 20 hasta dâhil edildi. Tüm hastalar işlem öncesi ve sonrasında oksijene edildi. Standart anestezi monitörizasyonu ve 0,05 mg.kg-1 midazolam intravenöz olarak uygulandı. Nazofarinks, %10 topikal lidokain sprey ile hazırlandıktan sonra en az 3 dk boyunca 0,07 μgr.kg.dk-1 hızda sürekli remifentanil infüzyonu verildi. Storz C-MAC, Storz D-Blade, McGrath MAC X-Blade ve Airtraq ile uyanık video laringoskopi rastgele aynı hastaya uygulandı. Bulgular: İki kadın hasta katılmayı reddetti ve 18 hasta analiz edildi. Bir hasta Airtraq'in derine yerleştirilmesine izin vermedi, böylece uyanık değerlendirmede Airtraq için 17 hasta analizimiz oldu. Hastaların demografik ve havayolu verileri benzerdi. Optimal görüntüyü elde etme zamanı gruplar arasında benzerdi. Hastanın ve gözlemcinin konfor derecelendirmesi C-MAC'de düşüktü (p<0,001). Cormack-Lehane evreleri C-MAC'de diğerlerine kıyasla kötüydü (p=0,006). Krikoid bası ile Cormack-Lehane evreleri video laringoskoplar arasında benzerdi. Airtraq ve C-MAC video laringoskoplarında daha fazla öğürme refleksi gelişti (p=0,007). Sonuç: Zor laringoskopinin öngörülmesinde yeni araç olarak, Airtraq, McGrath MAC X-Blade ve Storz D-Blade, uyanık video laringoskopik değerlendirmede Storz C-MAC'den üstündür.
Anahtar Kelimeler: Laringoskoplar; entübasyon; havayolu yönetimi
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