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Medicine

使用柔性插管内窥镜作为猪安全气道管理的标准化模型的气管插管

Published: August 25, 2022
doi:
10.3791/63955
, , , , , , ,
1Department of Anesthesiology,University Medical Center of the Johannes Gutenberg-University

Summary

近年来，猪在研究中的使用有所增加。然而，猪的特点是气道解剖困难。通过演示如何进行内窥镜引导的气管插管，本协议旨在进一步提高实验动物的安全性，以避免动物痛苦和不必要的死亡。

Abstract

气管插管通常是猪模型中需要安全气道或高通气压的各种干预措施的转化研究的基本要求。气管插管是一项具有挑战性的技能，需要最少次数的成功气管插管才能在最佳条件下达到高成功率，这对于非麻醉学研究人员来说通常是无法实现的。由于猪气道解剖结构的特殊，通常可以假设气道困难。无法建立安全的气道可能导致实验动物受伤、不良事件或死亡。使用前瞻性、随机、对照评估方法，已经表明，光纤辅助气管插管需要更长的时间，但比传统插管具有更高的首过成功率，而不会引起临床相关的血氧饱和度下降。该模型为内镜引导的气管插管提供了一种标准化方案，提供了安全的气道，特别是对于在通过直接喉镜 进行 气管插管技术方面缺乏经验的研究人员。预计该程序将最大限度地减少动物痛苦和不必要的动物损失。

Introduction

气管插管通常是猪模型转化研究的基本要求，用于需要安全气道或高通气压（例如心肺复苏期间通气1或急性呼吸窘迫综合征2）或要求脑血流不会因声门上气道装置的内部压迫而受损的各种干预措施3，偶尔在猪4，5的预期困难气道背景下作为替代物传播。

虽然猪的肺生理学显示出与人类相似的特征6，但由于猪口腔解剖结构的特定差异，有时保护气道明显更困难7。猪的鼻子开口窄，舌头很大，喉部活动性极强，会厌相对较大，游离端延伸到软腭。在尾部，喉部与气管形成钝角。枸杞软骨大8.气道最窄的部分位于声门下9层，与儿童10的气道解剖结构相当。由于猪的喉部活动性很强，因此气管插管末端有可能穿过声带，但喉部只会在尾部移位几厘米，这可能会被误认为是正确的插管8，11。此外，在处理猪气道管理时，食管插管是一种常见风险12.

对实验或早期死亡率有相应负面影响的气管插管困难或不可能的发生率尚未系统记录，但已发表几份病例报告13，14。在人类中，有可能在意外困难的传统插管的情况下使用柔性插管内窥镜15。在采取这项措施之前，通常会进行各种假插管。这些反复插管尝试与人类的不良事件有关16，17，尤其是气道并发症18。这些事件在试验动物中是有害的，因为在最简单的情况下，它们代表了实验中的一个混杂变量;在最坏的情况下，它们可能导致不必要的动物损失。

本研究根据人类预期困难气道管理指南开发了一个模型15，19，20，21，22，23，24。以前，在人体研究中已经描述了用于学习光纤插管的类似技术25，26。本报告中提出的方案旨在提供一种标准化且易于适应的插管模型，该模型还允许非气道专家在猪中进行成功和安全的气管插管。

Protocol

该协议中的实验得到了国家和机构动物护理委员会（Landesuntersuchungsamt Rheinland-Pfalz，科布伦茨，德国;批准号G20-1-135）的批准。实验是按照ARRIVE指南进行的。总体而言，本研究使用了10头平均体重为30公斤±2公斤，日龄为12-16周的麻醉公猪（Sus scrofa homea）。 1. 动物制备 为动物保持正常的环境，以尽量减少压力。在预定的实验前6小时停止进食以降低误?…

Representative Results

在前瞻性、随机、对照研究环境中对10头公猪（12-16周龄，体重30公斤±3公斤）进行了气管插管。将猪随机分为两组：一组常规喉镜插管（CI组），另一组通过方案中描述的柔性插管内窥镜 辅助 插管（FIE组）。小组作业是通过拉密封的信封来完成的。研究者每天随机分配。 该研究由麻醉实习生进行，他们具有3年以上的麻醉经验，对人类气道管理有深刻的了解，并且在猪…

Discussion

在之前的研究中，我们的研究小组已经描述了有关猪模型2，27，32，33的转化益处的具体细节。一般来说，降低动物的压力水平和不必要的疼痛应该是任何研究方案的一个组成部分，对于产生可靠的可重复数据至关重要。因此，对预期气道困难的猪进行清醒内镜引导的插管不是一种选择。

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Disclosures

The authors have nothing to disclose.

Acknowledgements

作者要感谢Dagmar Dirvonskis的出色技术支持。

Materials

Ambu aScope Regular Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany Disposable fiber optic outer diameter 5 mm
Ambu aView Monitor Ambu GmbH, Medizinprodukte, Bad Nauheim, Germany monitor
Atracurium Hikma 50 mg/5mL Hikma Pharma GmbH, Martinsried atracurium
Azaperone (Stresnil) 40mg/mL Lilly Deutschland GmbH, Bad Homburg, Germany azaperone
BD Discardit II Spritze 2, 5, 10, 20 mL Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain syringe
BD Luer Connecta Becton Dickinson Infusion Therapy, AB Helsingborg, Schweden 3-way-stopcock
BD Microlance 3 20 G Becton Dickinson S.A. Carretera, Mequinenza Fraga, Spain cannula
Curafix i.v. classics Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany Cannula retention dressing
Engström Carestation GE Heathcare, Madison USA ventilator
Fentanyl-Janssen 0.05 mg/mL Janssen-Cilag GmbH, Neuss fentanyl
Führungsstab, Durchmesser 4.3 Rüsch endotracheal tube introducer
IBM SPSS Statistics for Windows, Version 20 IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) Statistical software
Incetomat-line 150 cm Fresenius, Kabi Deutschland, GmbH perfusor line
Intrafix Primeline B. Braun Melsungen AG, Melsungen, Germany Infusion line
JOZA Einmal Nitril Untersuchungshandschuhe JOZA, München, Germany disposable gloves
Laryngoscope, 45.48.50, KL 2000 Medicon Laryngoscope handle
Littmann Classic III Stethoscope 3M Deutschland GmbH, Neuss, Germany stethoscope
Luer Lock B.Braun Melsungen AG, Germany
Maimed Vlieskompresse Maimed GmbH, Neuenkirchen, Germany Fleece compress to fix the tongue
Masimo LNCS Adtx SpO2 sensor Masimo Corporation Irvine, Ca 92618 USA saturation clip for the tail
Masimo LNCS TC-I SpO2 ear clip sensor Masimo Corporation Irvine, Ca 92618 USA Saturation clip for the ear
Masimo Radical 7 Masimo Corporation Irvine, Ca 92618 USA periphereal oxygen saturation
Midazolam 15 mg/3 mL Hameln Pharma GmbH, Hameln, Germany midazolam
Midmark Canine Mask Small Plastic with Diaphragm FRSCM-0005 Midmark Corp., Dayton, Ohio, USA dog ventilation mask
Octeniderm farblos Schülke & Mayr GmbH, Nordenstedt, Germany Alcoholic disinfectant
Original Perfusor syringe 50 mL B.Braun Melsungen AG, Germany perfusor syringe
Perfusor FM Braun B.Braun Melsungen AG, Germany syringe pump
Propofol 2% 20 mg/mL (50 mL flasks) Fresenius, Kabi Deutschland, GmbH propofol
RÜSCH Führungsstab für Endotrachealtubus (ID 5.6 mm) Teleflex Medical Sdn. Bhd, Malaysia PVC coated tube guiding wire
Rüschelit Super Safety Clear >ID 6/6.5 /7.0 mm Teleflex Medical Sdn. Bhd, Malaysia endotracheal tube
Stainless Macintosh Größe 4 Welch Allyn69604 blade for laryngoscope
Sterofundin B.Braun Melsungen AG, Melsungen, Germany Balanced electrolyte solution
Ultrastop Antibeschlagmittel bottle with dropper 25 mL Sigmapharm Arzneimittel GmbH, Wien, Austria Antifog agent
Vasofix Safety 22 G-16 G B.Braun Melsungen AG, Germany venous catheter
VBM Cuff Manometer VBM Medizintechnik GmbH, Sulz a.N., Germany cuff pressure gauge
Zelette Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany Tissue swab
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Tags

Endotracheal IntubationFlexible Intubation EndoscopeAirway ManagementSwineAnesthesiaLaryngoscopyEndotracheal TubeTracheaCuff Pressure

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Mohnke, K., Riedel, J., Renz, M., Rissel, R., Ziebart, A., Kamuf, J., Hartmann, E. K., Ruemmler, R. Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine. J. Vis. Exp. (186), e63955, doi:10.3791/63955 (2022).
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