Risk factors affecting the difficulty of fiberoptic nasotracheal intubation
이승현, 윤혜주, 김지은, 감명환, 유승화, 김현정, 서광석,
소속 상세정보
이승현 ( Rhee Seung-Hyun ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
윤혜주 ( Yun Hye-Joo ) - Catholic University College of Medicine Eunpyeong St. Mary’s Hospital Department of Anesthesiology and Pain Medicine
김지은 ( Kim Ji-Eun ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
감명환 ( Karm Myong-Hwan ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
유승화 ( Ryoo Seung-Hwa ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
김현정 ( Kim Hyun-Jeong ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
서광석 ( Seo Kwang-Suk ) - Seoul National University School of Dentistry Department of Dental Anesthesiology
Abstract
Background: The success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI).
Methods: FNI was performed by 18 anesthesiology residents under general anesthesia in patients over 15 years of age who underwent elective oral and maxillofacial operations. In all patients, the Mallampati grade was measured. Laryngeal view grade under direct laryngoscopy, and the degree of secretion and bleeding in the oral cavity was measured and divided into 3 grades. The time required for successful FNI was measured. If the intubation time was > 5 minutes, it was evaluated as a failure and the airway was managed by another method. The failure rate was evaluated using appropriate statistical method. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were also measured.
Results: A total of 650 patients were included in the study, and the failure rate of FNI was 4.5%. The patient's sex, age, height, weight, Mallampati, and laryngoscopic view grade did not affect the success rate of FNI (P > 0.05). BMI, the number of FNI performed by residents (P = 0.03), secretion (P < 0.001), and bleeding (P < 0.001) grades influenced the success rate. The AUCs of bleeding and secretion were 0.864 and 0.798, respectively, but the AUC of BMI, the number of FNI performed by residents, Mallampati, and laryngoscopic view grade were 0.527, 0.616, 0.614, and 0.544, respectively.
Conclusion: Unlike in intubation under direct laryngoscopy, in the case of FNI, oral secretion and nasal bleeding had a significant effect on FNI difficulty than Mallampati grade or Laryngeal view grade.
키워드
Difficult Intubation; Fiberoptic Nasotracheal Intubation; laryngeal View; Mallampati Grade; Risk Factors
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