GlideScope视频喉镜和直接喉镜在新生儿气管插管中的比较
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Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates.
背景：GlideScope视频喉镜（GS）已被广泛用于促进成人和儿科患者的气管插管，因为它可以改善声门视图。在儿科患者中进行的一些研究表明，与直接喉镜（DL）相比，GS喉镜可以更好地观察声门。然而，到目前为止，还没有研究评估新生儿中GS的使用。因此，当GS或DL用于新生儿气管内插管时，我们进行了一项前瞻性研究，以比较插管时间（TTI）。
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方法：70名新生儿（ASA I和II级，计划在全身麻醉下接受择期手术）随机分为GS组（n = 35）和DL组（n = 35）。该研究的主要结果是TTI，还评估了所有新生儿第一次插管尝试的成功率、插管尝试和不良事件作为次要结果。用GS和DL获得的声门视图进行比较（由Cormack和Lehane [C＆L]等级描述）。
结果：所有C＆L级别的新生儿TTI均无显着差异（95％CI，-7.36至4.44）。C和L级别I和II的新生儿亚组也没有差异（每组n = 30; 95％CI，-0.51至5.04）。然而，与DL相比，GS显着缩短了C＆L III和IV级新生儿的TTI（每组n = 5; 95％CI，4.94-46.67）。与DL相比，GS改善了声门视图。尽管GS组气管插管总数少于DL组（36 vs 41），但差异无统计学意义（P = .19）。
结论：与DL使用相比，GS使用并未降低所有C＆L I级和II级新生儿和新生儿的TTI;然而，GS显着降低了C＆L III和IV级新生儿的TTI。此外，GS使用提供了改进的声门视图。
BACKGROUND GlideScope video laryngoscope (GS) has been widely used to facilitate tracheal intubation in adults and pediatric patients because it can improve glottic view. Several investigations performed in pediatric patients have shown that GS provides a better view of the glottis than direct laryngoscope (DL). However, to date, there are no studies assessing the use of GS in neonates. Therefore, we conducted a prospective study to compare time to intubate (TTI) when either GS or DL was used for endotracheal intubation in neonates.METHODS Seventy neonates (American Society of Anesthesiologists physical status I and II, scheduled to undergo elective surgery under general anesthesia) were randomized to GS group (n = 35) and DL group (n = 35). The primary outcome variable of the study was TTI. As secondary outcomes, success rate of first intubation attempt of all neonates, intubation attempts, and adverse events were also evaluated. The glottic views (depicted by Cormack and Lehane [C&L] grades) obtained with GS and DL were compared.RESULTS There were no significant differences in TTIs of neonates with all C&L grades (95% CI, -7.36 to 4.44). There was also no difference in the subgroups of neonates with C&L grades I and II (n = 30 each; 95% CI, -0.51 to 5.04). However, GS significantly shortened the TTIs of neonates with C&L grades III and IV compared to DL (n = 5 each group; 95% CI, 4.94-46.67). GS improved the glottic view as compared to DL. Although the total tracheal intubation attempts in the GS group was fewer than that in the DL group (36 vs 41), there was no significant difference (P = .19).CONCLUSIONS GS use did not decrease the TTI of all neonates and neonates with C&L grades I and II as compared to DL use; however, GS significantly decreased the TTI of neonates with C&L grades III and IV. Additionally, GS use provided improved glottic views.
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