Comparison of effectiveness of intubation by way of

Esra Yildiz Sut; Solmaz Gunal; Mehmet Akif Yazar; Beyazit Dikmen

doi:10.1016/j.bjane.2016.03.001

Scientific Article

Comparison of effectiveness of intubation by way of "Gum Elastic Bougie" and "Intubating Laryngeal Mask Airway" in endotracheal intubation of patients with simulated cervical trauma

Comparação da eficácia de intubação por meio de guia introdutor Bougie de tubo endotraqueal e máscara laríngea em intubação traqueal de pacientes com trauma cervical simulado

Esra Yildiz Sut; Solmaz Gunal; Mehmet Akif Yazar; Beyazit Dikmen

http://dx.doi.org/10.1016/j.bjane.2016.03.001 Braz J Anesthesiol, vol.67, n3, p.238-245, 2017

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Abstract

Abstract Purpose: In this study, we evaluated the effectiveness of intubations by way of "Gum Elastic Bougie" and "Intubating Laryngeal Mask Airway" in endotracheal intubation of patients with simulated cervical trauma. Method: 134 patients were included in the study. All patients were placed cervical collar for a simulated cervical trauma. Patients were allocated randomly into three groups: Group NI (n = 45) intubation with Macintosh laryngoscopy, Group GEB (n = 45) intubation with Gum Elastic Bougie, and Group ILMA (n = 44) intubation with Intubating Laryngeal Mask Airway. The number of intubation attempts, success of intubation, duration of complete visualization of the larynx, duration of intubation, user's performance score, hemodynamic changes and the observed complications were recorded. Results: Success of intubation in the first attempt was highest in Group GEB while it was lowest in Group ILMA. Regarding the intubation success, rates of successful intubation were 95.6%, 84.4% and 65.9% in Groups GEB, NI, and ILMA, respectively. Durations of visualization of larynx and intubation were shorter in Groups NI and GEB than in Group ILMA. This difference was statistically significant (p < 0.05) while there was no significant difference between Groups NI and GEB. The number of patients with "good" intubation performance was significantly higher in Group GEB while the number of patients with "poor" intubation performance was significantly higher in Group ILMA (p < 0.05). Conclusions: We conclude that GEB, which is cheap and easily accessible, should be an advantageous choice in cervical trauma patients for both the easeness of intubation and patient morbidity and mortality.

Keywords

Difficult airway, Cervical trauma

Resumo

Resumo Objetivo: Neste estudo avaliamos a eficácia de intubações por meio de guia introdutor Bougie e máscara laríngea em intubação endotraqueal de pacientes com trauma cervical simulado. Método: Foram incluídos no estudo 134 pacientes. Colar cervical foi colocado em todos os pacientes para um trauma cervical simulado. Os pacientes foram alocados aleatoriamente em três grupos: Grupo NI (n = 45) foi submetido à intubação com laringoscópio Macintosh; Grupo ITE (n = 45) foi submetido à intubação com guia introdutor de tubo endotraqueal e Grupo ML (n = 44) foi submetido à intubação com máscara laríngea. Número de tentativas de intubação, sucesso de intubação, tempo de visualização completa da laringe, tempo de intubação, escore de desempenho do usuário, alterações hemodinâmicas e complicações observadas foram registrados. Resultados: O sucesso da intubação na primeira tentativa foi maior no Grupo ITE e menor no grupo ML. Ainda em relação ao sucesso da intubação, as taxas de sucesso foram 95,6%, 84,4% e 65,9% nos grupos ITE, NI e ML, respectivamente. Os tempos de visualização da laringe e de intubação foram menores nos grupos NI e ITE do que no Grupo ML. Essa diferença foi estatisticamente significativa (p < 0,05), enquanto não houve diferença significativa entre os Grupos NI e ITE. O número de pacientes com bom desempenho na intubação foi significativamente maior no grupo ITE, enquanto o número de pacientes com mau desempenho na intubação foi significativamente maior no grupo ML (p < 0,05). Conclusões: Concluímos que o ITE, que é barato e facilmente acessível, deve ser uma opção vantajosa em pacientes com trauma cervical, tanto pela facilidade de intubação quanto devido à taxa de morbidade e mortalidade dos pacientes.

Palavras-chave

Via aérea difícil, Trauma cervical

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