Application of Wei's nasopharynx airway combined with electrically-operated flexible scope for transnasal tracheal intuba-tion in children with difficult airways
Objective To explore the feasibility and safety of the application of Wei's nasopharyngeal airway combined with electrically-operated flexible scope for transnasal tracheal intubation in children with difficult airways.Methods A total of 40 chil-dren with difficult airway,aged 8-12 years,who underwent surgery who underwent surgery under general anesthesia with tracheal intu-bation in Jinjiang Hospital from July 2021 to July 2023 were selected.According to the random number table method,they were divid-ed into two groups(n=20):a Wei's nasopharynx airway combined with electrically-operated flexible scope group(group W)and a direct tracheal intubation with electrically-operated flexible scope group(group D).No muscle relaxants were administered before airway opening.In group W,anesthesia was induced by 8％sevoflurane+8 Umin oxygen flow by mask inhalation+2 p.g/kg remifentanil by in-travenous injection.When the children's bispectral index(BIS)was＜60,the Wei's nasopharyngeal airway was inserted into one side of the nasal cavity and an anesthesia assistant performed hand-controlled constant-frequency supra-glottal jet ventilation through the naso-pharyngeal airway,while anesthesia physicians used an electrically-operated flexible scope to intubate through the other side of the na-sal cavity.In group D,anesthesia was induced by 8％sevoflurane+8 Umin oxygen flow by mask inhalation.When the children's BIS was＜75,they were intubated through one side of the nasal cavity with an electrically-operated flexible scope,and the scope was with-drawn when the pulse oximetry saturation(SpO2)dropped to 90％,and oxygen was administered under pressure by mask.Then they were intubated again when the SpO2 rebounded to more than 99％.Then,mean arterial pressure(MAP),heart rate,minimum SpO2,the number of intubation,the success rate of one-time intubation,total time to intubation,BIS value at intubation,and the incidence of post-operative complications were recorded in the two groups before intubation(T0)and at the moment of successful intubation(T1).Re-sults Compared with group D,group W showed decreases in BIS value at intubation,the number of intubation,and total time to intu-bation(all P＜0.05),and decreases in the success rate of one-time intubation(all P＜0.05).At T1,the MAP and heart rate of patients in group W were lower than those in group D(all P＜0.05),and the minimum SpO2 was higher than that in group D(P＜0.05).There was no statistical difference in the incidence of postoperative complications between the two groups(all P＞0.05).Conclusions Compared with direct tracheal intubation with electrically-operated flexible scope,the combination of Wei's nasopharyngeal airway and transnasal tracheal intubation with electrically-operated flexible scope has reduced hemodynamic fluctuations in children with difficult airway,group W exhibited less hemodynamic fluctuation,higher minimum SpO2 values,and a higher success rate for single-attempt intubation,with shorter total intubation time and without increased postoperative complications,but it required the involvement of an anesthesiolo-gist assistant.
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