Preoperative Assessment And Clinical Study Of Intubation With GLIDESCOPE Vodeo Laryngoscope In Patients With Obstructive Sleep Apnea-hypopnea Syndrome

Part I Preoperative Assessment of Patients with Obstructive Sleep Apnea-hypopnea SyndromeObjective: To make an appropriate preoperative assessment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) for reducing the perioperative risk.Methods: Demographic data, preoperative organ conditions and airway conditions were observed in 106 patients with OSAHS. The mouth opening, Mallampati grade, thyromental distance, atlanto-occipital extension, length of the horizontal branch of mandible, body mass index (BMI), neck collar, apnea-hypoventilation index (AHI), Cormack-Lehane(C-L) grade and mask ventilation were recorded ,according to which the induction method was selected.Results: The complications occurred in circulatory, respiratory, liver and endocrine system. The most one was hypertension in 30 patients (28%), followed by abnormal electrocardiogram in 15 patients (14%). According to the American Society of Anesthesiologists (ASA) grading, 43 patients (41%) were in ASAⅠgrade, 63 patients (59%) in ASAⅡ. It was estimated that 3 patients (3%) were in easy intubation and 103 patients (97%) in difficult intubation. There were 2 patients in C-LⅣgrade (the absolute difficult intubation), and 4 patients possible in difficult mask ventilation. A total of 6 patients were used awake endotracheal intubation with fiberoptic bronchoscope. And 100 patients were used rapid induction endotracheal intubation.Conclusions: The combination of organ dysfunction and difficult airway are often existed in patients with OSAHS, so correct preoperative assessment should be made, and proper induction method should be selected to reduce the risk of anesthesia management.Part II Clinical Study of Nasotracheal Intubation with GlideScope Video Laryngoscope in Patients with Obstructive Sleep Apnea-hypopnea SyndromeObjective: In this study, we observed the glottis exposure, the times and time of intubation and the hemodynamic changes of the GlideScope video laryngoscope(GSVL) or the Macintosh direct laryngoscope(MDL) for nasotracheal intubation in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods: One hundred patients who were estimated that rapid induction endotracheal intubation could be used were allocated into either the GSVL group or the MDL group. Cormark-Lehane(C-L) grade, times and time of successful tracheal intubation and hemodynamic changes during nasotracheal intubation were recorded. The rate-pressure product (RPP) at all the measuring points was calculated.Results: The C-L gradeⅠ～Ⅱand the success rate of the first intubation were obtained respectively in 96% and 98% of patients with GSVL, which were higher than those in 47% and 84% with MDL.The intubation time in GSVL group[(41.7±14.8) seconds] was shorter than that in MDL group[(51.3±21.0) seconds].In both groups, noninvasive blood pressure (BP) and rate-pressure product (RPP) decreased from baseline values after induction, but heart rate (HR) remained stable; HR was higher than the baseline values at intubation and the first two minutes after intubation; BP and RPP were higher than the baseline values at intubation and the first minute after intubation. The difference of HR and BP in two groups was not statistically significant.Conclusions: The better C-L grade, higher success rate of the first intubation and shorter intubation time were obtained in nasotracheal intubation with the GSVL in patients with OSAHS than those with the MDL, but the same hemodynamic effects.