| Objective: Video laryngoscopy improves the glottis exposure and decreases the failure rate of endotracheal intubation,but not increases the first-pass success rate.Various factors such as glottis visualization,pre-shaped angulation of tube and bend of tube tip are all correlated with first-pass success.Of which,optimal tracheal tube shaping is one of the key point to deliver the tube to the glottis opening.In clinic,it is also be found that the tube was not easy to access to glottis as result of inappropriate tube shaping when by using video laryngoscope for endotracheal intubation.Therefore,how to model the tracheal tube deserves advanced study.Present study aimed to compare the effects of different tube shaping on endotracheal intubation,explore the optimal tracheal tube shaping for video laryngoscope endotracheal intubation,increasing the first success rate of endotracheal intubation and reducing the risk of complications,in order to provide theoretical guidance for clinical application and teaching.Methods: Three hundreds patients with aged above 18 years old,ASA I-II,who underwent surgical procedure and administered tracheal intubations by video laryngoscopy under general anesthesia,were included.Those who were accompanied with chronic systemic disease,or with predicted difficult airway,or accepted for oropharyngeal surgery,were excluded.Patients were randomly divided into three groups based on different shaping of tracheal tube,(100 in each group).Group A: the shaping of tracheal tube based on specialized stylet manufactured by manufacturer;Group B:modeling the tracheal tubes based on the shape of video laryngoscope;Group C: stylet bend angle based on the shape of video laryngoscope,but the bend point is at the proximal cufmodeling the tracheal tubes based on the shape of video laryngoscope.After induction of conventional anesthesia,endotracheal intubation was performed by the same experienced anesthesiologist with video Laryngoscope.The main outcomes included the first-pass success rate,the number of intubation and intubation time.The secondary outcomes were time to glottic exposure,hemodynamic changes before and after intubation,and complications.RESULTS: Three hundreds patients included were successfully conducted by endotracheal intubation.There was no significant difference in age,height,weight,gender,Mallampati classification,thyromental distance and interincisor distance among three groups(P>0.05).The number of patient in first-passs success was respectively 68(68%)in Group A,86(86%)in Group B,92(92%)in Group C.Patients in group C had higher first-pass success rate compared with A groupB(P<0.05).At the same time,compared with group A and B,patients in group C had less number of intubation(1.03±0.18 vs 2.53±0.56 vs 1.82±0.50,P<0.05)and shorter intubation time(17.71±3.47 vs 22.21±4.01 vs 19.92±4.1,P<0.05),but no significant difference in time to glottic exposure(10.10±1.82 vs 9.60±1.80 vs 9.65±1.61,P>0.05).Additionally,significant difference were not noted in SBP and HR before and after intubation and risk of complications such(P>0.05).Conclusion: With the bend point is at the proximal cuff,modeling the tracheal tubes based on the shape of video laryngoscope could increase the first-pass success rate and decrease the intubation time when endotracheal intubation was performed by using video laryngoscope. |
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