Heinrich S, Birkholz T, Irouschek A, Ackermann A, Schmidt J
Department of Anesthesia, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany,
J Anesth. 2013 Dec;27(6):815-21. doi: 10.1007/s00540-013-1650-4. Epub 2013 Jun 9.
Hypoxemia caused by difficulties in airway management presents a major cause for perioperative morbidity and mortality. The ability to predict difficult laryngoscopy more accurately would enable anesthesiologists to take specific precautions to reduce airway risks and prevent patient-threatening events.
Over a 6-year period of time, all anesthesia records with a documented direct laryngoscopic view were retrieved from the electronic data management system and statistically processed. The Cormack-Lehane four-point scale of grading laryngoscopy was used to assess visibility of the vocal cords.
Of 102,306 cases, the overall rate of difficult laryngoscopy was 4.9 %. Male gender (6.5 %), Mallampati score III and IV (17.3 %), obesity with a BMI ≥35 kg/m(2) (6.1 %), as well as physical status ASA III or IV (6.2 %), were identified as risk factors for difficult laryngoscopy. Patients undergoing surgery in the departments of oromaxillofacial (8.9 %), ear nose throat surgery (ENT) (7.4 %), and cardiac surgery (7.0 %) showed the highest rates of difficult laryngoscopy.
The results indicate that the risk for difficult airway situations might substantially differ between surgical patient groups. In hospitals with departmental structures and spatially separated operating rooms, the deduction might be increased awareness and particular structural preparation for difficult airway situations in the respective subspecialties.
气道管理困难导致的低氧血症是围手术期发病和死亡的主要原因。更准确地预测困难喉镜检查的能力将使麻醉医生能够采取特定预防措施以降低气道风险并防止危及患者的事件发生。
在6年时间里，从电子数据管理系统中检索出所有记录了直接喉镜检查视野的麻醉记录并进行统计处理。采用Cormack-Lehane喉镜检查四点分级量表来评估声带的可视度。
在102306例病例中，困难喉镜检查的总体发生率为4.9%。男性（6.5%）、Mallampati评分III级和IV级（17.3%）、BMI≥35 kg/m²的肥胖患者（6.1%）以及美国麻醉医师协会（ASA）身体状况分级III级或IV级（6.2%）被确定为困难喉镜检查的危险因素。在口腔颌面外科（8.9%）、耳鼻喉科（ENT）（7.4%）和心脏外科（7.0%）接受手术的患者中，困难喉镜检查的发生率最高。
结果表明，不同手术患者群体出现气道困难情况的风险可能存在显著差异。在具有科室结构且手术室空间分隔的医院中，可能需要提高对各专科气道困难情况的认识并进行特殊的结构准备。
