在模拟困难气道场景中，Macintosh直接喉镜与C-MAC®及King Vision®视频喉镜插管时上肢肌肉活动与工作负荷的比较：一项随机交叉试验

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中文摘要

目的： 气管插管对麻醉科医师而言是一项体力和精神上要求很高的操作，因为它需要精细运动控制、技术精准性、快速决策、情境意识和避免差错。虽然视频喉镜可减少正常气道中的肌肉紧张，但其在困难气道管理中的工效学影响仍不明确。我们旨在比较在模拟困难气道场景中，经直接喉镜（DL）与视频喉镜（VL）插管时采用动态表面肌电图测量的上肢肌肉活动。
方法： 我们开展了一项随机交叉试验，纳入35名经验丰富的麻醉科医师，分别在高保真人体模型上对正常气道、牙关紧闭和颈部僵硬情况进行气管插管，使用Macintosh直接喉镜、C-MAC®视频喉镜（C blade）和King Vision®通道式视频喉镜。主要结局为通过表面肌电图测量的上肢肌肉活动。次要结局包括插管时间、对上切牙的力、首次尝试成功率和感知工作负荷（美国国家航空航天局任务负荷指数[NASA-TLX]评分）。
结果： 在模拟正常气道（16 vs 13 µV；中位差[MD]，3 µV；95%置信区间[CI]，0至5；P = 0.04）、牙关紧闭（18 vs 12 µV；MD，6 µV；95% CI，1至11；P = 0.02）和颈部僵硬（16 vs 13 µV；MD，4 µV；95% CI，0至9；P = 0.03）场景中，直接喉镜产生的肱桡肌肌肉活动显著高于C-MAC VL。直接喉镜是最快的方法，但对切牙施加的力最高（P < 0.001）。King Vision VL与最高的NASA-TLX工作负荷评分相关（与DL相比P < 0.001），而C-MAC VL的要求最低。
结论： 在模拟困难气道中，与DL相比，VL减少了上肢肌肉活动。然而，King Vision VL的感知工作负荷高于DL，而C-MAC VL则较低。在测试的设备中，C-MAC VL提供了最有利的工效学平衡，在所有气道场景中结合了减少的肌肉紧张、较低的感知工作负荷和最高的首次尝试成功率。
研究注册： 印度临床试验注册中心（CTRI/2021/11/038305）；首次提交于2021年11月26日。

英文摘要

PURPOSE: Tracheal intubation is a physically and mentally demanding for anesthesiologists because it requires fine motor control, technical precision, rapid decision-making, situational awareness, and error avoidance. While videolaryngoscopes reduce muscle strain in normal airways, their ergonomic impact during difficult airway management remains poorly established. We aimed to compare upper limb muscle activity using dynamic surface electromyography during intubation via direct laryngoscopy (DL) vs videolaryngoscopy (VL) in simulated difficult airway scenarios.
METHODS: We conducted a randomized crossover trial involving 35 experienced anesthesiologists who performed tracheal intubation on a high-fidelity manikin with a normal airway, locked jaw, and rigid neck, respectively, using a Macintosh direct laryngoscope, a C-MAC® videolaryngoscope (C blade), and a King Vision® channeled videolaryngoscope. The primary outcome was upper limb muscle activity, measured by surface electromyography. Secondary outcomes included intubation time, force on upper incisors, first-attempt success rate, and perceived workload (National Aeronautics and Space Administration Task Load Index [NASA-TLX] score).
RESULTS: Direct laryngoscopy produced significantly higher brachioradialis muscle activity than C-MAC VL in the simulated normal airway (16 vs 13 µV; median difference [MD], 3 µV; 95% confidence interval [CI], 0 to 5; P = 0.04), locked jaw (18 vs 12 µV; MD, 6 µV; 95% CI, 1 to 11; P = 0.02), and rigid neck (16 vs 13 µV; MD, 4 µV; 95% CI, 0 to 9; P = 0.03) scenarios. Direct laryngoscopy was the fastest method but exerted the highest force on the incisors (P < 0.001). King Vision VL was associated with the highest NASA-TLX workload score (P < 0.001 compared with DL), whereas C-MAC VL was least demanding.
CONCLUSION: In simulated difficult airways, VL reduced upper limb muscle activity compared with DL. Nevertheless, perceived workload was higher with King Vision VL than with DL, whereas it was lower with C-MAC VL. Among the devices tested, C-MAC VL provided the most favorable ergonomic balance, combining reduced muscle strain, lower perceived workload, and highest first-attempt success rate across all airway scenarios.
STUDY REGISTRATION: Clinical Trials Registry of India (CTRI/2021/11/038305); first submitted on 26 November 2021.