Objective

In this study, we aimed to assess the feasibility of fiberoptic intubation (FOI), using a new, self-designed, “tongue root holder” device, in combination with the jaw thrust maneuver.

Methods

Three hundred patients undergoing elective surgery requiring orotracheal intubation were enrolled. Patients presented at least one or more risk factors for difficult airway. The patients were randomly allocated at a 1:1 ratio to one of two groups: group L, FOI with tongue root holder, or group C, standard FOI. Orotracheal FOI was performed after commencement of anesthesia. The jaw thrust maneuver was applied in both groups to facilitate advancement of the fiberoptic bronchoscope. The primary endpoint was the feasibility of FOI. The secondary endpoints were number of attempts, time to intubation, and airway clearance at the soft palate and epiglottis levels.

Results

The FOI was achieved in all 150 patients in group L, significantly higher than that in group C (100% vs 95.3%; P = 0.015). Less attempts of intubation were made in group L (P = 0.039). Mean time to successful intubation on the first attempt was shorter in group L (P < 0.001). The mean times to view the vocal cord and carina were also shorter in group L (P = 0.011 and P < 0.001, respectively). Airway clearance was better in group L at both the soft palate and the glottis levels (P = 0.010 and P = 0.038, respectively).

Conclusions

This study shows that FOI is feasible with the newly introduced, self-designed, “tongue root holder” device, when combined with the jaw thrust maneuver in patients with risk factors for difficult airway. The device also provides better airway clearance, less intubation attempts, and shorter time to intubation at first attempt.

Clinical relevance

Fiberoptic bronchoscope has been the gold standard for routine management of difficult airway. A technique to open the airway is introduced to reduce the incidence rate of upper airway obstruction.

中文翻译：

---

一种新的自行设计的“舌根支架”装置，用于辅助光纤插管。

客观的

在这项研究中，我们旨在评估光纤插管 (FOI) 的可行性，使用一种新的、自行设计的“舌根支架”装置，并结合下颌推力动作。

方法

招募了 300 名接受经口气管插管的择期手术的患者。患者表现出至少一种或多种困难气道的危险因素。患者以 1:1 的比例随机分配到以下两组之一：L 组，带有舌根支架的 FOI，或 C 组，标准 FOI。麻醉开始后进行口气管 FOI。两组均采用下颌推力动作，以促进纤维支气管镜的推进。主要终点是 FOI 的可行性。次要终点是尝试次数、插管时间以及软腭和会厌水平的气道清除率。

结果

L 组所有 150 名患者均达到 FOI，显着高于 C 组（100% vs 95.3%；P  = 0.015）。L 组插管尝试次数较少（P  = 0.039）。L 组首次尝试成功插管的平均时间较短（P  < 0.001）。L 组观察声带和隆突的平均时间也较短（分别为P  = 0.011 和P  < 0.001）。L 组软腭和声门水平的气道清除率均较好（分别为P  = 0.010 和P  = 0.038）。

结论

这项研究表明，在有困难气道风险因素的患者中，结合新推出的自行设计的“舌根支架”装置，FOI 是可行的。该装置还提供更好的气道清除、更少的插管尝试和更短的首次尝试插管时间。

临床相关性

纤维支气管镜一直是困难气道常规管理的金标准。引入一种打开气道的技术，以降低上气道阻塞的发生率。