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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 870-874. doi: 10.19723/j.issn.1671-167X.2019.05.013

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Study on the use of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway

Hong HONG1,Yu-ting QIAN1,Lei FU2,Wu WANG2,Cheng-hui LI1,Yi-qing YIN1,△()   

  1. 1. Department of Anesthesiology,China-Japan Friendship Hopital,Beijing 100029, China
    2. Department of Medical Image,China-Japan Friendship Hopital,Beijing 100029, China
  • Received:2018-05-20 Online:2019-10-18 Published:2019-10-23
  • Contact: Yi-qing YIN E-mail:yyq518@sina.com
  • Supported by:
    Supported by Capital Characteristic Clinical Application Research and Promotion Fund(Z141107002514112)

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Abstract:

Objective: To evaluate the significance of CT three-dimensional reconstruction technique for guiding tracheal intubation with rigid fiber bronchoscope in difficult airway. Methods: In this study, 44 patients undergoing selective operation of ASA (American Society of Anesthesiologists physical status) Ⅰ to Ⅱ, neck stiffness, neck trauma needed braked, or severe cervical spondylosis were selected. The patients were randomly divided into two groups: 24 cases in the experimental group (group E) and 20 cases in the control group (group C). The stylets of the rigid fiber bronchoscopes were shaped according to the CT three-dimensional reconstruction images and parameters obtained before surgery. The rigid fiber bronchoscopes shaped according to the CT three-dimensional reconstruction images were used in group E, while the rigid fiber bronchoscopes with the original angles were used in group C. Tracheal intubation operations were all performed by an anesthesiologist who had more than 10 years’ clinical experience and mastered in rigid endoscopic intubation techniques. The first attempt success rate and the total success rate of tracheal intubation, intubation time, blood pressure, heart rate and pulse oxygen saturation at different time points including pre-induction, immediately after intubation, 1-5 minutes after intubation, and intubation related complications within 24 hours were recorded. Results: The total success rate of intubation in the two groups were both 100%. The first attempt success rate of intubation was 96% in group E, and 70% in group C. The first attempt success rate of group E was higher than that of group C. The intubation time of group E was (20.7± 10.6) s, and (21.5 ± 17.6) s of group C. Group E was shorter than that of group C, but there was no significant difference (P > 0.05). RPP equaled the product of heart rate and systolic pressure, which represented the stress reaction of intubation on hemodynamics, was lower in group C at T0, T1, T2, T4 and T5 separately than that in group E, but there was no significant difference (P>0.05). There was no significant difference in tracheal intubation related complications between the two groups (P>0.05). Conclusion: CT three-dimensional reconstruction technique has certain guiding significance in difficult tracheal intubation with rigid fiber bronchoscope in patients with fixed cervical spine.

Key words: CT three-dimensional reconstruction technique, Rigid fiber bronchoscope, Fixed cervical spine, Difficult tracheal intubation

CLC Number: 

  • R614

Figure 1

The interface of CT three-dimensional reconstruction technique workstation,the stylets of the rigid fiber bronchoscopes were shaped according to the intubation path simulated in the workstation"

Figure 2

The rigid fiber bronchoscopes with shaped and original angles"

Table 1

Demographic data of two groups"

Group Gender, male/female Age/years, x?±s Height/cm, x?±s Weight/kg, x?±s BMI/(kg/m2), x?±s
E 15/9 55.6±8.6 165.8±8.2 71.1±19.2 25.9±7.2
C 10/10 57.4±14.0 164.2±7.0 64.6±12.2 23.8±3.1
P 0.405 0.625 0.483 0.200 0.245

Table 2

Patient airway assessment"

Group Angle of upper airway measurement on CT imaging/(°), x?±s OSAS, yes/no Mouth opening/cm, x?±s* Thyromental distance/cm, x?±s
E 89.63±10.35 16/8 4.60±0.59 4.42±0.87
C 85.65±7.85 9/11 4.65±0.49 4.90±0.94
P 0.165 0.149 0.783 0.510
Group Front teeth missing, yes/no Upper lip bite test,
Ⅰ/Ⅱ/Ⅲ		 Length of mandibular
ramus/cm, x?±s		 Cormack-lehaneclassifcation,
Ⅰ/Ⅱ/Ⅲ/Ⅳ
E 22/2 8/12/4 8.44±1.45 1/5/13/5
C 19/1 12/5/3 8.68±1.35 1/1/15/3
P 0.662 0.175 0.580 0.396

Figure 3

RPP of the two groups at each time points Ar, arrival at the OR; Im, immediately after intubation; 1, 1 minute after intubation; 2, 2 minutes after intubation; 3, 3 minutes after intubation; 4, 4 minutes after intubation; 5, 5 minutes after intubation."

Table 3

Intubation data and complications"

Group First attempt success rate of
intubation/%		 Intubation time/s, x?±s TbRPP/[×103 beat/
(min·mmHg)], x?±s		 T0RPP/[×103 beat/
(min·mmHg)], x?±s		 T1RPP/[×103 beat/
(min·mmHg)], x?±s
E 96(23/24) 20.7±10.6 7.9±2.1 9.2±2.4 9.7±2.2
C 70(14/20) 21.5±17.6 7.0 ±1.9 9.4±3.1 9.9±2.9
P 0.035 0.880 0.149 0.846 0.810
Group T2RPP/[×103 beat/
(min·mmHg)], x?±s		 T3RPP/[×103 beat/
(min·mmHg)], x?±s		 T4RPP/[×103 beat/
(min·mmHg)], x?±s		 T5RPP/[×103 beat/
(min·mmHg)], x?±s		 Post-operative
complication rate/%
E 8.5±2.0 8.1±1.8 7.5±1.5 7.1±2.0 37.5 (9/24)
C 8.8±2.5 8.1±2.1 7.7±1.8 7.5±1.8 15 (3/20)
P 0.655 0.982 0.780 0.504 0.201
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