頸椎手術を受けている患者における困難なMcGrath MACビデオ喉頭鏡検査の放射線画像予測因子

Radiographic Predictors of Difficult McGrath MAC Videolaryngoscopy in Patient Undergoing Cervical Spine Surgery.

• Sehee Yoon
• Hyongmin Oh
• Hyun-Kyu Yoon
• Hyung-Chul Lee
• Hee-Pyoung Park

抄録

背景:

McGrath MACビデオ喉頭鏡は，頸椎損傷患者の挿管時に頸部を手動でインラインで安定させて挿管を成功させるために有用な手技である．頸椎手術を受けた患者において、McGrath MACビデオ内視鏡検査が困難な場合のX線写真上の予測因子を明らかにすることを目的とした。

BACKGROUND: McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery.

方法:

2016年6月から2018年8月までの間に，頸部の手動インライン安定化下でMcGrath MACビデオ喉頭鏡で挿管した頸椎手術を受けた患者を本研究の対象とした．術前の側方頸椎X線、磁気共鳴画像、コンピュータ断層撮影（CT）スキャンから得られた気道関連の変数とX線画像指標に関するデータをレトロスペクティブに収集した。挿管時間と挿管回数を基準に、患者を難易度の高いMcGrath MACビデオaryngoscopic挿管群と難易度の低いMcGrath MACビデオaryngoscopic挿管群に分けた。

METHODS: Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts.

結果:

このうち33例（18％）はビデオ喉頭挿管が困難な症例であった。015）、頸部磁気共鳴画像またはコンピュータ断層撮影の中矢状面における舌面積/口腔面積比（OR, 1.12; 95% CI, 1.05-1.19; P<0.001）、および咬合間隙（OR, 0.92; 95% CI, 0.98; P=0.015）は、困難なビデオaryngoscopic挿管の独立した危険因子であった。

RESULTS: In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation.

結論:

頸椎手術を受けた患者で、挿管中に手動で頸椎を安定化させている患者では、口腔内に対する舌の肥大と首の伸展が制限されていることを示すX線写真の変数は、困難なMcGrath MACビデオ挿管と関連していた。

CONCLUSIONS: Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.