| Background and ObjectiveIn order to ensure airway patency of the patients at the different of position and the effective airway management during surgery, it need to endotracheal intubationl. The tradition method of endotracheal intubation is carried on under the guidance of Macintosh direct laryngoscope. It requires patient’s head backward as far as possible to make the mouth, pharynx, larynx3-axis overlap. The operator places the laryngoscope lens in epiglottis valley to expose glottis with the help of raising the laryngoscope,then Inserts the tracheal tube under direct vision. In clinical work, we often come across patients with difficult airway because of various factors,a variety of complication will most likely occure if using Macintosh laryngoscope for endotracheal intubation directly for such patients. It is hard to expose glottis and insert the tracheal tube for such patients, intubation time will be longer, the occurrence of the complication such as hypoxemia and hypercapnia will be higher. It often need to exert larger lift force forward above to expose the glottis,this is likely to damage throat bleeding or teeth loosing or falling off and so on. It makes endotracheal intubation more difficultly and even cause emergency airway,so there is no guarantee that for patients with oxygen demand. Tooth falling into the airway can cause airway obstruction,it may cause hypoxemia because of difficult ventilation. Tooth falling into the esophagus cause foreign body in digestive tract. Patient’s comfort and satisfaction will be reduced after operating. In the process of the endotracheal tube into the trachea or when the glottis exposed, a variety of factors such as the stimulation to the trachea mucosa can excite the sympathytic nervous system, elevate the concentration of the blood carecholamine, enhance myocardial contraction force, increase the heart rate and peripheral vascular resistance, that made patients’blood pressure increased, arrhythmia, and even cardiac arrest. The imbalance of myocardial oxygen consumption and the instability of hemodynamics increased the risk of myocardial ischemia, cerebral hemorrhage and other serious complications. It is important how to control stress response occurred during the process of the endotracheal tube into the trachea in some special patients, such as patients with cardiovascular disease or hemodynamic instability. The guideline of the difficult airway managemengt developed by the ASA pointed out that the preoperative assessment of airway can help anesthesiologists make airway managemengt strategy, reduce the incidence of adverse events, It is very important for preoperative airway management. Mallampati classification is one of the best indicators to predict difficult airway and sill is used by most anesthesiologists, although there are a lot of research question the prediction value of difficult airway. Modified of Mallampati grading improve the accuracy of the predicting difficult airway. Research shows that modified Mallampati classification, a mental distance and degree of mouth is the best predictor for laryngoscope revealing difficulties. Modified Mallampati class Ⅲ and Ⅳ suggest the glottis appeared difficulties, and exist difficult intubation.In recent years, technology related to endotracheal intubation made great progress, especially the development of visualization endotracheal intubation technique, it not only improves the success rate of tracheal intubation, but also reduces the incidence of complications related to endotracheal intubation. HC-video laryngoscope is designed on the base of Asian throat anatomy. While it has the feature of high rates of successed intubation and low rats of complications at the normal patients. But there are nearly no research about the use of HC video laryngoscope in the patients with Mallampati grade Ⅲ or Ⅳ. So the purpose of our study is to compare the Macintosh direct laryngoscope with the HC video laryngoscope in orotrcheal intubation in the patients with Mallampati grade Ⅲ or Ⅳ to observe the exposure of the glottic, time to intubation, the risk of the complications and the hemodynamic responses to orotracheal intubation,and assess the efftiveness and safety of using the HC application video laryngoscope on patients with Mallampati grade Ⅲ or IV to provide theoretical reference for the clinical application.MethodsWith ethics committee approval from The First Affiliated Hospital of Zhengzhou University, and written informed consent, ninety-four ASA Ⅰ～Ⅱ patients, aged18-65yr, Mallampti Ⅲ or Ⅳ, undergoing elective surgery, were included in this study. They were randomly divided into2groups(n=47each):HC video-laryngoscope group (group H) and Macintosh laryngoscope (group M). The patients in group H were intubated with HC video-laryngoscope while the patients in group M were intubated with Macintosh laryngoscope after rapid sequence induction. The blood pressure, the HR, were recorded at the time of before the induction (TO), before the intubation (T1), at the time of intubation (T2), lmin after the intubation (T3),3min after the intubation (T4) and5min after the intubation (T5),and calculate MAP and RPP. We also record the time to exposure the glottic, time to intubation at the first attempt, totle time of intubation, Cormack-Lehane grade and complications of the intubation.Results1. There was no significant difference in the time of exposure the glottic and the time to intubation at the first attempt(p>0.05); The totle time of intubation of group M is longer than group H; The situation of glottic view in H group is obviously better than M group, there are statistical significance between two groups(P<0.05).The satisfaction rating was85.1%in H group significantly higher than M group(53.2%) Group M needs more times of Cricoid cartilage pressure(12:2)(P<0.05);. 2. The difference of hemodynamic changes between two group has no statistical significance(P>0.05).The BP,HR,MAP,RPP of two groups after anesthesia induction decreased significantly (P<0.05). The index above mentioned increased significantly at the moment of tracheal intubation compared with Tl(P<0.05). The index decreased gradually in lminute after tracheal intubation and has no statistical significance with the baseline. At the time of T4and T5, the SBP, DBP, MAP of the both group are lower than at the time of T0. While the HR and RPP of group M at the time T5are significantly lower than at the time of T1, the index of group H has has no statistical significance with the the time of Tl.ConclusionHC video-laryngoscope, Compared with the Macintosh laryngoscope in the orotracheal intubation of the patients with Mallampati Ⅲ or Ⅳ, can provide better glottic exposure view, shorter intubation time, higher success intubation rate, lower rates of complications. |
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