Department of Women's & Obstetric Anesthesia, IWK Health Centre, 5859/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada,
Can J Anaesth. 2011 Jun;58(6):514-24. doi: 10.1007/s12630-011-9491-9. Epub 2011 Apr 7.
Difficult and failed tracheal intubation may be more common in the obstetrical population. The objective of this study was to determine the incidence of difficult and failed tracheal intubation in a Canadian tertiary care obstetric hospital and to identify predictors.
Maternal, perinatal, and anesthetic information on all pregnant women or recently pregnant (up to three days postpartum) women undergoing general anesthesia (GA) from 1984 to 2003 at the Izaac Walton Killam Health Centre (IWK) was abstracted from the Nova Scotia Atlee Perinatal Database, and the information was augmented by chart review. The incidence and predictors of difficult and failed tracheal intubation were determined. Analyses using logistic regression were performed for the complete GA cohort and for the subgroup that had Cesarean delivery under GA.
There were 102,587 deliveries of ≥20 weeks gestation in the study population, with 3,107 GAs identified, 2,986 records reviewed, and 2,633 GAs (88%) retained in the complete cohort. Difficult tracheal intubation was encountered in 123 of 2,633 (4.7%) women in the complete cohort and 60 of 1,052 (5.7%) women in the Cesarean delivery subgroup. Only two failed tracheal intubations were identified (0.08%) in the complete cohort, and both occurred during GAs for postpartum tubal ligation. The combined rate of difficult/failed tracheal intubation remained stable over the 20 years reviewed despite decreasing GA rates. Amongst the complete cohort, maternal age ≥35 yr, weight at delivery 90 to 99 kg, and absence of labour predicted increased risks; while weight at delivery 90 to 99 kg and absence of labour amongst the Cesarean delivery subgroup predicted difficult/failed tracheal intubation.
Previously accepted risk factors, such as labour, pre-existing medical conditions and obstetrical disorders, did not predict an increased risk of difficult tracheal intubation, while maternal age ≥35 yr, weight 90 to 99 kg, and absence of active labour were found to predict increased risk.
困难和失败的气管插管在产科人群中可能更为常见。本研究的目的是确定加拿大一家三级产科医院困难和失败的气管插管发生率，并确定预测因素。
从 1984 年至 2003 年在 Izaac Walton Killam 健康中心（IWK）接受全身麻醉（GA）的所有孕妇或近期怀孕（产后三天内）女性的产妇、围产期和麻醉信息均从新斯科舍省 Atlee 围产期数据库中提取，并通过图表审查进行了补充。确定了困难和失败的气管插管的发生率和预测因素。对完整 GA 队列和进行 GA 下剖宫产的亚组进行了逻辑回归分析。
在研究人群中，有 102,587 例≥20 周妊娠分娩，有 3,107 例 GA 确定，2,986 份记录审查，2,633 例 GA（88%）保留在完整队列中。在完整队列中的 2,633 名女性中，有 123 名（4.7%）遇到困难的气管插管，在剖宫产亚组中的 1,052 名女性中有 60 名（5.7%）遇到困难的气管插管。在完整队列中仅发现 2 例气管插管失败（0.08%），均发生在产后输卵管结扎 GA 期间。尽管 GA 率下降，但在 20 年的审查中，困难/失败的气管插管综合发生率保持稳定。在完整队列中，母亲年龄≥35 岁、分娩体重 90 至 99 公斤和无临产预测风险增加；而剖宫产亚组中分娩体重 90 至 99 公斤和无临产预测困难/失败的气管插管。
以前公认的危险因素，如临产、既往疾病和产科疾病，并未预测气管插管困难的风险增加，而≥35 岁的母亲年龄、90 至 99 公斤的体重和无临产被发现预测风险增加。
