| Objective:Tracheal intubation is the core skill of anesthesiologists in handling airways.During perioperative anesthesia,the success of endotracheal intubation insertion directly relates to the prognosis of the surgical patient.According to statistics,30% of deaths from anesthesia are related to intubation,and more than 85% of respiratory complications can lead to brain damage or death.Especially for patients with difficult airways,the above rates are even worse.Open-laryngoscope in patients with difficult airway intubation,poor throat exposure,resulting in excessive laryngoscope exposure to laryngeal structures,increased irritation of the tongue and throat tissue,and repeated blind probe insertion of endotracheal intubation to the tracheal mucosa Increased stimuli,increased stress response during operation,tracheal spasm,increased blood pressure,and increased heart rate can increase myocardial oxygen consumption,induce arrhythmia,increase the risk of anesthesia,and length of hospital stay.The most serious is the accident.Difficult intubation will increase the mortality rate;and it will cause damage to the laryngeal mucosa,edema,and even the formation of granulomas,leading to increased incidence of sore throat,hoarseness,and chronic pharyngitis in patients,which is not conducive to the implementation of painless,A comfortable medical model;and it is likely to cause a dispute over poor doctor-patient relationships.Therefore,the selection of convenient and safe intubation apparatus is one of the hot spots for clinical anesthesiologists.The domestically researched Airtraq video laryngoscope is a new type of tracheal intubation tool designed for routine or difficult airway intubation.It is designed so that the glottis can be seen without the overlap of the triple line of the mouth,pharynx andthroat.And the regular size Airtraq laryngoscope only has to open to 18 mm.It transmits the image to the near-end viewfinder through a combination of a lens and a prism,so that the glottis,the anatomy around the glottis,and the tip of the endotracheal intubation can be seen.The entire process of endotracheal intubation can be visualized,with simplicity,controllability,and visibility,significantly increasing throat exposure and reducing irritation to the base of the tongue and throat.The new domestic laryngoscope of the HC video laryngoscope is more suitable for the pharynx structure of the Asian population.It can extend the operating vision to the front and the top of the blade and closer to the throat.Applicable to complete neck movement limitation,difficult intubation of C/L3-4(Cormack-Lehane 3-4 grade)and restrictive open mouth patients,direct intubation,and reduced intubation injury.The FOB(Fiberoptic bronchoscope)fiberoptic bronchoscope is a commonly used device for solving difficult airways,and has low requirements for mouth opening and cervical motion,and has little stimulation to the tongue base and throat.However,the characteristics of small visual field and vulnerability to secretions increase the difficulty of operation and require higher operating technology.However,the characteristics of small visual field and vulnerability to secretions increase the difficulty of operation and have higher requirements on operating techniques.In recent years,there have been a large number of literatures comparing the intubation of video laryngoscopes and traditional Macintosh laryngoscopes.Most of them are compared in non-difficult airway patients and confirmed during the intubation process.Stimulation-induced stress response and hemodynamic stability can be seen in the chemical industry has obvious advantages.However,with regard to intubation time and the lack of a clear conclusion about the success rate of first intubation,compared with direct-view laryngoscopes,some studies have found that straight-laryngoscopes prolong the intubation time,and some studies believe that the intubation time is shortened or similar.Therefore,previous studies have shown that when used with a single-lumen endotracheal intubation,video laryngoscopes have no advantage over the traditional Macintosh laryngoscope for normal airways.In this study,Mallampati patients with difficult airways were selected and intubated under the guidance of threevisualization tools.By comparing intubation time,glottal exposure,stress response index,and hemodynamic changes,it was difficult to treat clinical anesthesia.Airway provides reference.Methods:A total of 60 patients undergoing orotracheal intubation under general anesthesia from March 2016 to February 2018 were selected from Hospital from March 2016 to February 2018.They were classified as ASA I-II,male or female,aged 18-60 years,and weighed 55-85 kg.Height 150-180 cm.Mallampati III ~ IV.The random number table was used to divide into 3 groups(n=20): FOB group(F group),Airtraq video laryngoscope group(group A)and HC video laryngoscope group(H group).After induction of anesthesia,these three visualization tools were used to perform endotracheal intubation,and the success rate of one intubation was recorded;tracheal intubation time(from end of mask ventilation to confirmation of catheter entry into the glottis);T0(before induction of anesthesia),T1(Intratracheal intubation),T2(immediately after intubation),T3(1min after intubation),T4(3min after intubation),T5(5min after intubation)systolic blood pressure(SBP),diastolic blood pressure(DBP)Heart rate(HR)values;blood glucose values at T0,T2,and T4,cortisol values at T0,T5(Cor);intubation injury,and glottal exposure in groups A and H.Results:1.Comparison of general data,intubation time,and intubation success rate:(1)The 3 sets of general data were not statistically significant(P>0.05).(2)There was no obvious difference in success rate of primary intubation in 3 groups(P>0.05).(3)The total intubation time in group 3F was significantly longer than that in group A and group H,P<0.01.2.Hemodynamic comparison:(1)Compared with T0,the SBP and DBP of the three groups of T1 were significantly lower(P<0.05),and there was no significant change in HR.There was no significant difference(P>0.05).(2)Compared with T1,SBP and DBP of T2 and T3 in group A increased,P<0.05,and HR did not change significantly during intubation,P>0.05.(3)Compared with T1,the blood pressure and heart rate at T2,T3,and T4 in H and F groups increased significantly(P<0.05).At T5,the HR in H and F groups was still higher than T1,P<0.05.(4)Compared with group A,T2,T3,and T4,HR,SBP and DBP in group H and group F increased significantly,P<0.05.groups H and F had higher HR than group A at T5,P<0.05.3.Comparison of blood glucose levels:(1)There was no significant difference in blood glucose levels between T1,T2,and T4 in group A(P>0.05).(2)The blood glucose levels of T2 and T4 in 2H and F groups were significantly higher than those in T0 and A groups(P<0.05).4.Comparison of Cor values:(1)There was no significant difference in Cor values in A group at T0 and T5(P>0.05).(2)Cor values in H and F groups at T5 were significantly higher than those at T0,P<0.05.(3)Compared with group A,Cor value in group H and F increased at T5,P<0.05.(4)Compared with group F,the cortical value of group H was not significantly increased(P>0.05).5.Comparison of intubation injury in 3 groups:(1)There was no loosening of teeth and oral bleeding in the 3 groups.(2)The incidence of sore throat in group A was significantly lower than that in group H(P<0.05).6.There was no significant difference in glottic exposure grading between group Aand group H(P>0.05).Conclusion:At the time of orotracheal intubation in patients with grade III or higher Mallampati,the three visualization tools had a high success rate;the Airtraq was more stable at the time of intubation;the HC laryngoscope had the fastest intubation time. |
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