Clinical Comparison Of Shikani Optical Style, Direct Laryngoscopes And Video Laryngoscope In Tracheal Intubation

Objective:To compare the intubation time, stimulus to the base of tongue and epiglottis, the hemodynamic responses, success rate exterted by Shikani Optical Style and direct laryngoscopes after induction of general anesthesia. To further identify target success rate intubation time using Shikani Optical Style and video laryngoscope when glottis, hypolarynx structure even epiglottis cann't be exposed. Then investigate the application value by Shikani Optical Style.Methods:The clinical trial was divided to two parts:one contrast test for Shikani Optical Style and direct laryngoscopes, the other for Shikani Optical Style and video laryngoscope in difficult tracheal intubation.Part1:Materials and methods: drug:midazolam fentanil propofol vecuronium lactated ringer's solution equipment:Shikani Optical Style, direct laryngoscopes, video laryngoscope, intubation packet produced by tuoren company.Study objects:the patients aged 18～65 year, ASAâ… -â…¡group scheduled for no head and neck selective operation and tracheal intubation in Linyi people's hospital of Shandong province. People with signs of significant cardiovascular, oral neoplasms, large mass of neck and anatomical texture confused as result of trauma. Group:According to the randomized design, all subjects were divided two groups: direct laryngoscopes(n=60) or Shikani Optical Style(n=60).All patients fasted overnight and were restricted from oral intake of clear fluid for two to three hours. They all were delivered premedication as usual. After patients entered the operating room, an intravenous (IV) cannula was inserted and noninvasive BP, HR, SPO2 were continuously monitored and inhaled 100% oxygen. Then midazolam 0.05mg/kg, fentanyl 2～3μg/kg, vecuronium 0.1 mg/kg and propofol 2-3 mg/kg were injected IV. The orotracheal intubation was started 2 min after vecuronium injection. All intubation procedures were performed by a three experienced anesthetist proficient in direct laryngoscopes and Shikani Optical Style.Variables measured:After the tracheal intubation was successfully accomplished, the tracheal tube was connected to the anesthesia breathing system for intermittent positive pressure ventilation, intubation time Ta,Tb(from starting to finishing).Systolic blood pressure and HR were recorded before induction(MAPla,HRla), epiglottis view with direct laryngoscopes(MAP2a,HR2a,),reach glottis with Shikani Optical Style(MAP2b,HR2b), tube get to tracheal (MAP3a,HR3a,MAP3b,HR3b),and the first 2 min after intubation(MAP4a,HR4a, MAP4b,HR4b).laryngopharyngeal bleeding, teeth droped and loose, oral lip injury, then examined laryngopharyngeal with fibrescopes. More than two attempt to achieve successful tracheal intubation using direct laryngoscopes, requiring>3min using Shikani Optical Style and changed the two way were record. In addition, throat discomfort and hoarseness were add.Result:50 cases were completed successfully for the first time and 7 cases were completed for the second time,3 case were failed when using direct larygoscopes.55 cases were completed successfully for the first time and 4 cases were completed for the second time,1 case were failed when using Shikani Optical Style. Successful rate were higher in group B than group A (p<0.05).The incidence rate for laryngopharyngeal injury and intubating time were lower in group B than group A (p<0.05). But the heart rate, blood pressure in both group at T1,T2,T3,T4 were not different (p>0.05).Conclusion:we found the Shikani Optical Style was better than the conventional direct laryngoscope with regard to the intubation time,successful rate and tissue injury,while both showed the similar the hemodynamic responses.Part 2:Materials and methods: drug:midazolam fentanil propofol vecuronium lactated ringer's solution equipment:Shikani Optical Style a, direct laryngoscopes and video laryngoscope intubation packet produced by tuoren company.Study objects:the patients aged 18～65 year, ASAâ… -â…¡group scheduled for no head and neck selective operation and tracheal intubation in Linyi people's hospital of Shandong province. People with signs of significant cardiovascular, oral neoplasms,large mass of neck and anatomical texture confused as result of trauma. Group:According to the randomized design, all subjects were divided two groups: video laryngoscope (N=15) or Shikani Optical Style(n=15).Variables measured:performed tracheal intubation, more than two attempt or requiring exceed 3min to achieve successful tracheal intubation by Shikani Optical Style were record. Meanwhile changing the two ways still not finished were incluced. Result:When glottis structure wasn't well display with direct larygoscopes,13 cases were accomplished successfully in Shikani Optical Style group, while 14 cases were accomplished in video laryngoscope group. The successful rate for both group was respectively 86.67%å'Œ93.33%.Conclusion:we conclude compared with video laryngoscope, Shikani Optical Style has no special advantages in completing intuabtion time and successful rate. This study suggests that the Shikani Optical Style is a slight injury, highly successful rate and learned very quickly.lt showed special advantages in dealing with difficult way especially glottis structure wasn't well display. The Shikani Optical Style would be a routine and useful in tracheal intubation.