| Endotracheal intubation is the best method to keep the airway open, supply the oxygen, clean the airway and prevent aspiration. While the airway lesion it caused and the complication of endotracheal intubation are the focus of all the anesthetists. Except for the mechanical injury to the teeth and laryngopharyngeal muscle of the patient, changes of respiratory system and cardiovascular system is often caused, which appear as tracheospasm, rise of intracranial pressure, rise of intraocular pressure, rise of biood pressure, rise of heart rate and arrhythmia and so on. Although all these compliments can be prevented by well preparation and rapid treatment, they can bring damages to the patients with cardiocerebralovascular system disease. Facing of all kinds of visual laryngoscope in clinical, it has always been the main direction of current research to seek a safe and quick and effective tool for intubation.In this study, we compare the time needed, success rate, degree of tissue injury and the changes of haemodynamics between using Discopo and Macintosh. We also compare the time needed, success rate,and the changes of haemodynamics between using Discopo and video laryngoscope to evaluates the clinical value of Discopo so that we can find a more handy endotracheal intubation method with higher success rate. ObjectiveTo compare the blood flow dynamics change and intubation success rate when use Discopo and ordinary laryngoscope intubation in non-difficult airway patints under general anesthesia; Compare the difference of intubation success rate and intubation time in patients with high Mallampati degree while using Discopo and the video laryngoscope.To discuss Discopo’s endotracheal intubation value.MethodsThe experiment is divided into two parts:the first part is the comparison between Discopo and conventional laryngoscopy; Part two is the comparison test between Discopo and video laryngoscope in patients with high Mallampati degree.Part1MaterialsDrugs:Fentanyl, propofol, succinylcholine injection, sodium lactate RingerMachinery and equipment:Discopo, Macintosh Laryngoscope, breathing machines, monitorsSubjects:80patients undergo elective non-head and neck surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University from June2012to December2012, aged18to60years old, ASA Ⅰ-Ⅱ grade, Mallapatil-2grade. Excluded those with cardiovascular diseases such as hypertension, coronary heart disease and those with huge neck tumor or trauma that could not properly exposed neck tracheal structure. Patient whose thyromental distance is greater than6.5cm or mouth opening is larger than3cm is expected to be non-difficult airway.Grouping:The object of study in advance were randomly divided into two groups:a group of ordinary laryngoscope (M) group with40patients, a group for Discopo (D) group with40patients. MethodsAll the patients included in the research were forbidden to eat8hours and drink4hours before the surgery, not to give any premedication; Open the intravenous access after the burglary, and intravenous infusion of lactated Ringer’s solution500ml. Connect the guardianship (blood pressure, ECG,pulse oximetry) conventionally, and oxygen (10L/min). Induction of anesthesia medication:fentanyl2ug/Kg, propofol2mg/Kg, succinate choline2mg/Kg. After the induction of anesthesia, the intubation was performed by the same anesthesiologist whose clinical experience is more than10years and could use ordinary laryngoscope and Indra endoscope skillfully.Observed index:Intubation time TD, TM (Begining from the laryngoscope inserted into the mouth to the end of the monitor showing the End-tidal carbon dioxide) and intubation times; mean arterial pressure (MAP), heart rate (HR)before the induction of anesthesia; mean arterial pressure (MAP-A), heart rate (HR-A) after induction of anesthesia; mean arterial pressure (MAP-B)and heart rate (HR-B) after the intubation, and mean arterial pressure and heart rate1-3minutes after intubation (denoted as T1, T2, T3). Record postoperative pain scores and throat pain scores, postoperative awake and the cases that obtain voice hoarse24hours after the surgery.ResultsAll intubations were completed successfully.Group M used ordinary laryngoscope for intubation once successful cases was36, the number with a second attempt was4; In group D, the number of once successful example was40, with a second attempt was0; Intubation success rate of group D was significantly higher than that in group M (p<0.05); The number of patients with teeth, mouth and throat tissue damage in ordinary the laryngoscope was5, while in group D the number was1, tissue injury in group D was significantly less than the group M(p<0.05). The intubation time between TD and TM had no difference (p>0.05). The changes in heart rate and blood pressure of the patients at every time point had no difference (p>0.05). ConclusionThe intubation time,one-time intubation success rate in patients using Discopo is better than those using ordinary laryngoscope. There is no significant difference in intubation time and hemodynamic change in both groups, but the incidence of tissue damage in the Discopo group is significantly lower than ordinary direct laryngoscopy group.Part2MaterialsDrugs:midazolam, fentanyl, etomidate, cisatracurium, lactated ringer’s solutionEquipments:Macintosh laryngoscope, Discopo, video laryngoscope, life-support machine, monitor.Subjects:80patients undergo elective non-head and neck surgery under general anesthesia at the First Affiliated Hospital of Zhengzhou University from June2012to December2012, aged18to60years old, ASA Ⅰ-Ⅱ grade. Excluded those with cardiovascular diseases such as hypertension, coronary heart disease and those with huge neck tumor or trauma that could not properly exposed neck tracheal structure. Patient whose thyromental distance is less than6.5cm or mouth opening is less than3cm.Grouping:The object of study in advance were randomly divided into two groups:a group of video Laryngoscope(V) group with40patients, a group for Discopo (D) group with40patients.MethodsAll of the included patients should fast about8hours and be forbidden to drink about4hours in routine preoperative, without any premedication.Open venous channels after burglary,infuse500ml lactated ringer’s solution by intravenous access, connect the regular guardianship(Blood pressure,ECQPulse oximetry) and inhale oxygen. Carry out the induction of anesthesia until the patient’s vital signs are stable(midazolam0.05mg/kg, fentanyl2ug/kg, etomidate0.3mg/kg, cis-atracurium0.2mg/kg),then conduct endotracheal intubation. First use the Macintosh laryngoscope to observe glottis, record Cormark-lehane grade, then use the Discopo or the video laryngoscope to conduct endotracheal intubation. All cases should be operated by a clinical anesthetist who works more than ten years and could use ordinary laryngoscope and Discopo skillfully.Observed index:Record the Cormark-lehane grade when the anesthetist use the Macintosh laryngoscope to view glottis and the Cormark-lehane grade when the anesthetist use the Discopo or the video laryngoscope, intubation time TD,TV(Begining from the laryngoscope inserted into the mouth to the end of the monitor showing the End-tidal carbon dioxide)and the frequency of intubation.Record the MAPs and HRs at any time point.Results36cases were accomplished successfully and4cases were accomplished by the second try in V group (the video laryngoscopes group),40cases were accomplished successfully and0case were accomplished by the second try in D group. The sueeessful rate for both groups were respectively90%and100%.The statistical difference was outstanding(p<0.05); The intubation time between TD and TV had no difference (p>0.05). The changes in heart rate and blood pressure of the patients at any time point had no difference (p>0.05).ConclusionThe success ratio of Discopo is higher than the video laryngoscope when the glottis is exposed dissatisfiedly in the treacheal intubation. Discopo is a simple, high success ratio intubation tool with less damage, and it has an advantage in patients who have difficulty in dealing with the glottis exposed.It can be used as a conventional endotracheal intubation tool. |
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