The Feasibility Use Of The Blind Tracheal Intubation Instrument And Fiberoptic Bronchoscope In The Patients With Difficult Intubation

Objective: This study was designed to assess the feasibility and advantages about the blind tracheal intubation (BTâ…¡) and fiberoptic bronchoscope using in difficult airway by comparing the oxygenation, cardiovascular responses of the patient and nasal oral injury.Methods: With ethical committee approval and informed consent, 60 ASAâ… orâ…¡patients, were randomly divided into 2 groups (n=30 each).The inclusion criteria contained: the size of oral opening < 3 cm, thyromental distance < 6 cm, the length of horizontal mandible < 9 cm, improved Mallampati scoring method of glossopharyngeal partⅢ～Ⅳ, the range of extension of atlanto-occipital joint < 25°(2 or more the 5 index mentioned above received tracheal intubation difficulty), and the patients undergoing the operation of cervical vertebrae or orofacial. Group A prepared nasal intubation under the guidance of blind tracheal intubation device and group B used the fiberoptic bronchoscope to intubation. Injecting fentanyl 2μg·kg^-1 and midazolam 0.02-0.04 mg·kg^-1 before tracheal intubation in patients both groups. Meanwhile giving the 3% ephedrine nasal and 4% tetracaine topical anesthesia and 2% tetracaine 2ml used for surface anesthesia endotracheal by cricothyroid membrane puncture. All patients were operated by the same anesthesiologists (who had more than 25 times operating training). The success rate of intubation, intubation time, anesthesia time, operative time and OAA/S grade after extubation were compared. Record the data before intubation(T₀), after intubation 1min(T₁), after intubation 5min(T₂), end of surgery(T₃), extubation(T₄) and extubation 5min (T₅) of the blood pressure, heart rate and SpO2. The oxygenation and cardiovascular response in patients were compared among the two groups. And the nose and mouth injury in patients were compared with nose and mouth bleeding immediately, throat discomfort, hoarseness, and laryngeal edema.Results(:1)There is no difference in age and weight among the three groups(P>0.05).(2)The difference of success rate of intubation, the time of intubation, the anesthesia time, the operative time and OAA/S grade between two groups are not statistically significant(P>0.05).(3)MAP and HR increased significantly in 1 min post-intubation compared to pre-intubation in both groups(P<0.05), and remained stable at each other time point(P>0.05). The differences of MAP and HR between two groups were not statistically significant(P>0.05).(4)There were differences in the incidence rate of nose and mouth bleeding immediately between two groups(P<0.05), and the incidence rate of throat discomfort, hoarseness, and laryngeal edema were not differences(P>0.05).Conclusion: The blind tracheal intubation instrument and fiberoptic bronchoscope had high security, simple, little effect on patients and worthy in the patients with difficult intubations, and the nose and mouth injury was slighter in the latter.