Prospektive, randomisierte, kontrollierte Studie zur Messung der Halswirbelsäulenreklination bei der Laryngoskopie zur endotrachealen Intubation mittels konventioneller Laryngoskopie und Videolaryngoskopie

Gegenstand: Die Intubation bei Halswirbelsäulentrauma sollte präklinisch unter bestmöglicher Immobilisation erfolgen. Der Nutzen der modernen Videolaryn-goskopie wird in diesem Zusammenhang aktuell kontrovers diskutiert. Vorliegende Arbeit vergleicht konventionelle und videolaryngoskopische Intuba...

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Bibliographic Details
Main Author: Riße, Joachim
Contributors: Wulf, Hinnerk (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2011
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Objective: Unconscious patients with severe trauma often require urgent endotra-cheal intubation. During intubation of trauma victims with possible cervical spine injury any movement of head and neck should be avoided. The use of the modern videolaryngoscopy is up-to-date controversially discussed in this connection. This study investigated the influence of videolaryngoscopy with GlideScope® on cervical spine movement during intubation compared with conventional laryngoscopy in an-aesthetized patients with unsecured cervical spine. A noninvasive measuring method was used for the first time. Methods: Therefore a clinical, prospektive, randomized, controlled study with 60 patients with general anaesthesias (Mallampati 1-3) was carried out. After induction of anaesthesia intubation was performed either with videolaryngoscopy (GlideScope®) (NMac=30) or conventional laryngoscopy (Macintosh) (NMac=30). Us-ing a videomotion analysis with a lateral view the maximum extension angle Alpha (main angle), Beta, Gamma and Delta were detected referring to defined anatomical points. Maximum extension angle and successful intubation were measured depend-ing on professional experience and method experience. Maximum angle deviation was measured and analyzed using Mann Whitney U-test. Results: Maximum deviation of mean angle Alpha (angle between baseline and a line drawn from Processus mastoideus to Os frontale; Glabella) was 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p=0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by phy-sicians experienced in videolaryngoscopy was associated with reduced angel deviation (α=10.3°) compared to inexperienced (12.8°, p = 0.019). In three patients random-ized to the conventional group (10%) conventional intubation failed but could be successfully performed using videolaryngoscopy. The results of angle delta con-firmed the results of the main angle Alpha, but unfortunately the further angle Beta and Gamma could not show this result. Conclusion: Videolaryngoscopy reduces movement of cervical spine in patients with unsecured cervical spine and therefore might reduce the risk of secondary dam-age during emergency intubation of patients with cervical spine trauma.