小児の気管挿管時のコルマック–レハン分類と外的喉頭操作に対する年齢の影響

The Effect of Age on the Cormack-Lehane Classification and External Laryngeal Manipulation during Pediatric Tracheal Intubation

要旨

　わが国において小児のコルマック–レハン（Cormack-Lehane，以下C-L）分類グレードの年齢別割合の報告は少なく，挿管手技に付随する外的喉頭操作（external laryngeal manipulation：ELM）の使用状況とELMを必要とする因子の調査報告はこれまでにない。今回，18歳未満の2,452症例の麻酔症例を対象とし検討した結果，C-L分類グレードⅢ・Ⅳの割合は新生児期・学童期以降で多いことがわかった。ELMは新生児期と学童期以降で多く使用されていた。ELMを必要とする因子については男性，C-L分類グレードⅢ・Ⅳ，新生児期・学童期以降であることであり，麻酔を担当する際には留意する必要がある。

　Background：There are few reports on the age-specific distribution of Cormack-Lehane（C-L）classification grades in children in Japan, and there have been no investigations into the use of external laryngeal manipulation（ELM）in association with intubation techniques and the factors requiring ELM.

　Methods：We conducted a retrospective investigation of the C-L classification grade, the presence/absence of ELM use, and factors necessitating the use of ELM in anesthesia for patients＜18 years old.

　Results：We retrospectively analyzed the uses of anesthesia in the surgeries conducted at our hospital during the period from Aug 2022 to Oct 2023 for 2,452 pediatric patients（1397 males, 1055 females, age range neonate to 18 years）. The analysis results demonstrated that（i）ELM was most frequently used in the anesthesia for neonates and school-age and older children, and（ii）the glottic view before the application of ELM was poorer in the neonates and children at school-age and older compared to the patients between the neonatal and school-age stages. The factors requiring ELM were being male, having an initial C-L classification grade Ⅲ or Ⅳ, being in the neonatal period compared to infancy or being school-age or older.

　Conclusions：The proportion of pediatric C-L grade Ⅲ/Ⅳ patients and the frequency of ELM use were greater in neonatal patients and those at school age or older. Factors requiring ELM were male sex, C-L grade Ⅲ/Ⅳ, neonatal period compared to infancy, and school age or higher age.