| Objective: General anesthesia is one of the main anesthesia methods in pediatric anesthesia.In clinical practice,the selection of endotracheal tube size in pediatric population.usually according to the physical parameters of children,such as age,height and weight.However,there are great individual differences in children's growth and development,which will lead to the inaccurate selection of endotracheal tube size and needs repeated intubation to determine the most suitable size of endotracheal tube.and,repeated intubation will lead to a series of serious complications.At present,clinical anesthesia is developing towards visualization and accurate.How to improve the accuracy of selection in endotracheal tube size in pediatric population has always been an issue for anesthesiologists.Studies at home and abroad have shown that the transverse diameter at the narrowwest portion of the subglottic airway measured by ultrasound can be used for the selection of endotracheal tube size in children.However,most studies have focused on the selection of cuffed endotracheal tube size in children under 5 years of age.Therefore,this study is to explore the clinical effect of measuring the transverse diameter at the narrowwest portion of the subglottic airway(MTDSA)in the selection of cuffed endotracheal tube size in a pediatric population,in order to provide reference for the selection of tracheal conduit in children(4-14 years old).Methods:The first part: 80 pediatric patients who scheduled for surgery requiring,endotracheal intubation under general anaesthesia.40 males and40 females,ASA physical status I or II.aged 4-14 years,were enrolled in the study.we empirically used the age based formula method(Motoyama-Khine,ID=age/4+4,)selected the cuffed endotracheal tube size(usually reduced by 0.5 to 1).After induction of general anesthesia,we used ordinary laryngoscope complete cuffed endotracheal intubation.After successful intubation,the selection of tube size whether reached a good a good clinical fit was determined by the air leak test and the actual situation.At the same time,we used ultrasound to measure the transverse diameter at the narrowwest portion of the subglottic airway(MTDSA)before induction of anesthesia and recorded.The specific implementation of the leak experiment is described in detail in the following research methods.For this cases of failure in first intubation,choose the type of replacement of tracheal tube and try intubation again until the intubation is successful ?Based on this fit reached cases,We did the correlation analysis between different factors which included the age,height,weight and the subglottic diameter,and the The internal diameter(ID)separately.and the linear regression equation between MTDSA measured by ultrasound and ID of the appropriate size of cuffed endotracheal tubes was also established.The second part: A total of 100 pediatric patients who scheduled for surgery requiring,endotracheal intubation under general anaesthesia.53 males and 47 females,ASA physical status I or II,aged 4-14 years,were enrolled in this study.They were randomly divided into two groups: ultrasound measurement group(D)and age based group(C),After induction of general anaesthesia,the two groups select the size of cuffed endotracheal tube according to the Linear regression equation established by MTDSA measured by ultrasound with The internal diameter ID and age based formula Separately.we used ordinary laryngoscope to complete tracheal intubation,After successful intubation,the selection of tube size whether reached a good clinical fit was determined by the air leak test and the actual situation.Then,We tested and analyzed the accuracy of the selection of cuffed endotracheal tube size by using the MTDSA measured by ultrasound with using age based formula.Results:The first part:judgment by the air leak test,there were 37 of the 80 children met the criteria of clinical optimal intubation.The SPARMAN rank correlation coefficients(rs)of age(age),height(cm),weight(kg),MTDSA(mm)measured by ultrasound and The internal diameter ID(mm)of the appropriate size of cuffed endotracheal tubes were 0.921,0.852,0.879 and 0.966(P < 0.05)Separately,which indicated that there were correlations between all this different factors and ID of the appropriate size of cuffed endotracheal tubes.Compared with other factors,the correlation between MTDSA measured by ultrasound and ID of the appropriate size of cuffed endotracheal tubes is the strongest.and the linear regression equation between MTDSA measured by ultrasound and ID of the appropriate size of cuffed endotracheal tubes was also established for ID=0.601*MTDSA+0.015(r=0.954).The second part:There was no significant difference in the general characteristics of 50 children in the two groups(P < 0.05).there were 40 cases met the optimal intubation criteria,10 cases did not In the D group,the optimal intubation accuracy rate was 80%(95% CI: 69%-91%).while there were 23 cases met the optimal intubation criteria,27 cases did not In the C group,the optimal intubation accuracy rate was 46%(95% CI: 32%-60%).the accuracy of the selection ofcuffed endotracheal tubesize by using the MTDSA measured by ultrasound was significantly higher than that with using age based formula.The difference was statistically significant(c2=12.40,P < 0.05,).The incidence of complications(Hoarseness,sore throat,throat spasm,etc)related to endotracheal intubationin D group was 10%(95% CI: 2-18%),which was significantly lower than that in C group 26%(95% CI: 14-38%).The difference was significant(c2 = 4.34,P < 0.05).Conclusion: Comparing with age-related formulas,the measurement of MTDSA airway transverse diameter under ultrasound can be used as a relatively accurate and simple method to guide the selection of the cuffed tracheal tube size in a pediatric population. |
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