기도확보가 어려운 상황에서 Miller blade와 Macintosh blade를 이용한 기관내삽관의 비교 : 숙련되지 않은 인턴을 대상으로 한 마네킨 연구
Comparison of tracheal intubation using the Miller blade versus Macintosh blade in difficult airway: A manikin study among novice intern doctors
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The purpose of this study was to compare laryngoscopic views and ease of use and success of intubation, via the percentage of glottic opening (POGO) scale when using the Miller blade and Macintosh blade in paraglossal approach. Methods: Forty intern doctors were randomized for laryngoscopy to be performed in a crossover manner. They performed endotracheal intubation with Miller blade and Macintosh blade in two airway scenarios: normal airway and difficult airway with edema. We observed the rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, ease of intubation, and the POGO scale. Results: In the normal airway, there was no difference in intubation between the two endoscopes. In the difficult airway, the time for visualizing the glottis (7.80 versus 10.24 sec; p=.006), the time to tube passage (19.38 versus 23.03 sec; p=.038) and the time to complete endotracheal intubation (21.84 versus 28.54 sec; p=.022) with Miller blade was shorter than with Macintosh blade. The POGO scale(%) of the Miller blade was higher than that of the Macintosh blade’s (62.25 versus 56.32; p=.030). Conclusion: Compared to the Macintosh blade, Miller blade provided better visualization of the glottis and POGO scale, and faster time to completion of endotracheal intubation.
Abstract
Purpose: The purpose of this study was to compare laryngoscopic views and ease of use and success of intubation, via the percentage of glottic opening (POGO) scale when using the Miller blade and Macintosh blade in paraglossal approach. Methods: Forty intern doctors were randomized for laryngoscopy to be performed in a crossover manner. They performed endotracheal intubation with Miller blade and Macintosh blade in two airway scenarios: normal airway and difficult airway with edema. We observed the rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, ease of intubation, and the POGO scale. Results: In the normal airway, there was no difference in intubation between the two endoscopes. In the difficult airway, the time for visualizing the glottis (7.80 versus 10.24 sec; p=.006), the time to tube passage (19.38 versus 23.03 sec; p=.038) and the time to complete endotracheal intubation (21.84 versus 28.54 sec; p=.022) with Miller blade was shorter than with Macintosh blade. The POGO scale(%) of the Miller blade was higher than that of the Macintosh blade’s (62.25 versus 56.32; p=.030). Conclusion: Compared to the Macintosh blade, Miller blade provided better visualization of the glottis and POGO scale, and faster time to completion of endotracheal intubation.
참고문헌 (19)
- 시종원, "정상 기도와 시뮬레이션된 어려운 기도 시나리오에서 매킨토시 후두경과 GlideScopeⓇ 비디오 후두경의 비교 - 마네킹 연구", 대한응급의학회지, 20(6), pp.604~608 (2009), 대한응급의학회
- H J Kim, "Comparison of the GlideScope video laryngoscope and Macintosh laryngoscope in simulated tracheal intubation scenarios", Emergency Medicine Journal, 25(5), pp.279~282 (2008), BMJ[DOI]
- Lizabeth D. Martin, "3,423 Emergency Tracheal Intubations at a University Hospital", Anesthesiology, 114(1), pp.42~48 (2011), Ovid Technologies (Wolters Kluwer Health)[DOI]
- D. Keith Rose, "The airway: problems and predictions in 18,500 patients", Canadian Journal of Anaesthesia, 41(5), pp.372~383 (1994), Springer Nature[DOI]
- Richard M. Cooper, "Expérience clinique préliminaire avec un nouveau vidéolaryngoscope (GlideScope®) chez 728 patients", Canadian Journal of Anesthesia, 2005, pp.52(2), 191~198[DOI]
- 최욱진, "경추고정 마네킹에게 직접후두경(Macintosh laryngoscope), 부지(Gum elastic bougie), 비디오후두경(Pentax Airway Scope)을 사용한 기관내삽관 비교", 한국응급구조학회지, 15(3), pp.71~80 (2011), 사단법인 한국응급구조학회
- 황지영, "초보자에서 마네킨에게 직접 후두경과 삽관용 후두마스크기도기를 이용한 기관내삽관의 비교", 한국응급구조학회지, 16(2), pp.75~89 (2012), 사단법인 한국응급구조학회
- 김정선, "기관내삽관 및 후두튜브 삽관의 교육지속효과 - 마네킨연구 -", 한국응급구조학회지, 20(3), pp.85~93 (2016), 사단법인 한국응급구조학회
- George Kovacs, "A Comparison of a Fiberoptic Stylet and a Bougie as Adjuncts to Direct Laryngoscopy in a Manikin-Simulated Difficult Airway", Annals of Emergency Medicine, 50(6), pp.676~685 (2007), Elsevier BV[DOI]
- Jonathan L. Benumof, "La laryngoscopie difficile: à la recherche de la meilleure exposition", Canadian Journal of Anaesthesia, 41(5), pp.361~365 (1994), Springer Nature[DOI]
- J. J. Henderson, "The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation", Anaesthesia, 52(6), pp.552~560 (1997), Wiley[DOI]
- Achen B, "View of the larynx obtained using the Miller blade and paraglossal approach, compared to that with the macintosh blade", Anaesth Intensive Care, 36(5), pp.717~721 (2008)
- Yu-Feng Huang, "Prevention of Dental Damage and Improvement of Difficult Intubation Using a Paraglossal Technique With a Straight Miller Blade", Journal of the Chinese Medical Association, 73(10), pp.553~556 (2010), Elsevier BV[DOI]
- Horton WA, "Factor analysis in difficult tracheal intubation: laryngoscopy-induced airway obstruction", Br J Anaesth, 65(6), pp.801~805 (1990)
- Majd Al Shamaa, "Lingual Tonsillar Hypertrophy: Airway Management Using Straight Blade Direct Laryngoscopy", Anesthesia & Analgesia, pp.874~ (2004), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Jose J. Arino, "Les lames droites améliorent la, visualisation du larynx tandis que les lames courbes facilitent l’intubation: une comparaison des lames Macintosh, Miller, McCoy, Belscope et Lee-Fiberview", Canadian Journal of Anesthesia, 2003, pp.50(5), 501~506[DOI]
- Bellhouse CP., "An angulated laryngoscope for routine and difficult tracheal intubation", Anesthesiology, 69(1), pp.126~129 (1988)
- Wojewodzka M, "Comparison of the Miller and Machintosh laryngoscopes in simulated pediatric trauma patient: a pilot study", Disaster and Emergency Medicine Journal, 2(1), pp.1~6 (2017)[DOI]
- K. B. Greenland, "A proposed model for direct laryngoscopy and tracheal intubation", Anaesthesia, 63(2), pp.156~161 (2008), Wiley[DOI]