Study On The Effectiveness And Safety Of Endotracheal Intubation By Video Laryngoscope For Patients With Difficult Airway

Study oneEffectiveness and safety of the videolaryngoscope for tracheal intubation in patients with difficult airway:a meta-analysisObjectiveTo evaluate the efficacy of the videolaryngoscope as the first choice for the patients with difficult airway.MethodsThe randomized controlled trial?RCT?about patients with difficult airway was selected,no limiteding the language.The direct laryngoscope was used in the control group,and videolaryngoscope was used in the experimental group.The main indexes were the success rate of intubation,the time of intubation,Cormack-lehane?C-L?,hemodynamic and postoperative complications.The database of Pubmed,Embase and Cochrane library is retrieved by"laryngoscope,intubation,clinical trial"as the retrieval words.The cut-off date was 2017.09.The work of literature screening,data extraction and quality evaluation was completed according to the inclusion and exclusion criteria.Two evaluators screened the literature and extracted the data independently,and evaluated the methodology quality of the included research.In case of disagreement,the discussion will be settled or the third parties are consulted.The content of the data extraction mainly includes the basic information of the study of the people,the basic characteristics of the test and the index of the outcome.The Jadad scale was used to evaluate the quality.The RevMan 5.3 software was used for meta analysis.RR was used in the two classification data.The continuous data used the MD.The confidence interval estimation used 95%CI.The heterogeneity of each study in the group?test level alpha=0.10?was determined by the chi ² test.The test level of Meta analysis:0.05.ResultsWe included 19 trials with a total of 2376 patients.The result of meta-analysis indicated that:1.The pooled RR with videolaryngoscope increased the incidence of successful first-attempt intubation was[RR=1.18,95%CI?1.13-1.23?,P=0.000].2.Thenonexpertsdecreasedthetimeofintubationusing videolaryngoscope[MD=-41.17s,95%CI?-69.42s--12.51s?],but these benefits were not seen with experts[MD=7s,95%CI?-3.27s-13.37s?].3.The pooled RR with videolaryngoscope increased the number of C-L grade I was[RR=1.61,95%CI?1.37-1.89?,P=0.000]and[RR=10.99,95%CI?6.94-17.40?,P=0.000]respectively.4.The 5 studies showed no significant difference about the hemodynamic by using two laryngoscopy in tracheal intubation.The 4 study showed that the effect of videolaryngoscope on hemodynamic was lower than that of direct laryngoscope.5.The pooled RR with videolaryngoscope decreased the incidence of postoperative complications was[RR=0.50,95%CI?0.32-0.78?,P=0.002].Study twoEffectiveness and safety of the videolaryngoscope for tracheal intubation in patients with difficult airway:one center,randomized controlled clinical studyObjectiveTo compare the efficacy and safety of videolaryngoscope and direct laryngoscope for tracheal intubation in patients with difficult airway.MethodsAccording to the inclusion criteria and exclusion criteria,120 cases of ordinary patients and 120 cases of difficult airway patients were selected.They were divided into direct laryngoscope group?group D?and videolaryngoscope group?group V?respectively,according to random number table,with 60cases in each group.All patients were treated with standardized general anesthesia:Dexmedetomidine 1ml/kg.h,propofol 1mg/kg-2mg/kg,sufentanil0.4ug/kg-0.6ug/kg,Rocuronium Bromide 0.5mg/kg.The anesthesia was maintained with propofol,remifentanil and sevoflurane.Three.Endotracheal intubation were performed by the anesthesiologist who was less than 5 years of clinical experience.Observated and recorded the basic information?sex,age,height,weight,BMI?and the basic airway.An assistant recorded patients'the mean arterial pressure?MAP?,heart rate?HR?,blood oxygen saturation?SpO₂?at 10min after enter operating room?T0?,induction of anesthesia?T1?,immediately after intubation?T2?,1min after intubation?T3?,2min after intubation?T4?,3min intubation after?T5?,5min after intubation?T6?,and recorded the intubation time,intubation times,laryngoscopy grade?C-L grade?and intubation complications after three days.Results1.The direct laryngoscope and videolaryngoscope had no significant difference about the general situation and the preoperative airway assessment?P>0.05?.2.The results of ordinary patient group showed that the first intubation success rate of direct laryngoscope and videolaryngoscope was?89.5%VS90.9%?,?P>0.05?;the first intubation success rate of the difficult airway group was?60.3%VS 92.5%??P<0.05?.3.The results of ordinary patient group showed that the intubation time of direct laryngoscope and videolaryngoscope was[?30.1+5.3?s VS?29.3+4.5?s]?P>0.05?;the intubation time of the difficult airway group was[?48.2+5.8?s VS?35.9+6.2?s]?P<0.05?.4.The results of ordinary patient group showed that the C-L grade I/II/III/IV of direct laryngoscope and videolaryngoscope respectively was?29/31/5/2 VS35/18/2/0??P>0.05?;the C-L grade I/II/III/IV of the difficult airway group respectively was?8/23/16/6 VS 17/21/17/1??P<0.05?.5.The ordinary patient group and the difficult airway group hadn't significant difference in hemodynamic between direct laryngoscope and videolaryngoscope?P>0.05?.6.The ordinary patient group hadn't significant difference in postoperative complications between direct laryngoscope and videolaryngoscope?P>0.05?,but there was a significant difference in difficult airway group?P<0.05?.ConclusionsMeta-analysis and clinical studies have shown that the effectiveness and safety of video laryngoscope are better than those of direct laryngoscopy in patients with difficult airway.Videolaryngoscope should be the preferred technique for tracheal intubation in patients with difficult airway.