Ovbey Dianna H, Wilson Deborah V, Bednarski Richard M, Hauptman Joe G, Stanley Bryden J, Radlinsky Maryann G, Larenza M Paula, Pypendop Bruno H, Rezende Marlis L
Departments of Anesthesia and Surgery, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
Vet Anaesth Analg. 2014 Mar;41(2):127-36. doi: 10.1111/vaa.12110.
To determine the incidence of canine post-anesthetic aspiration pneumonia (AP) and to identify anesthetic agents, procedures and management factors associated with the development of AP.
Multicenter, randomized, case-controlled retrospective study.
Two hundred and forty dogs affected with AP and 488 unaffected control dogs.
Electronic medical record databases at six Veterinary colleges were searched for dogs, coded for anesthesia or sedation and pneumonia from January 1999 to December 2009. The resultant 2158 records were hand-searched to determine eligibility for inclusion. Diagnosis of AP was made radiographically. Two unaffected control dogs were randomly selected for each affected dog, from a list of dogs that underwent sedation or anesthesia in the same time period and did not develop aspiration pneumonia. Fifty-seven factors were then evaluated for association with aspiration pneumonia. Data analysis was performed using univariate Chi-square or student t-tests, then multivariate logistic regression.
Incidence of post-anesthetic AP was 0.17%, from 140,711 cases anesthetized or sedated over the 10 year period. Two anesthesia-related events were significantly associated with development of AP: regurgitation and administration of hydromorphone at induction. Administration of anticholinergics was not associated with AP. Procedures associated with increased odds of aspiration pneumonia included laparotomy, upper airway surgery, neurosurgery, thoracotomy and endoscopy. Orthopedic surgery, ophthalmologic surgery, dental procedures, MRI, CT, bronchoscopy, cystoscopy, tracheoscopy and neutering were not associated with development of AP. Three patient factors were associated with the development of AP: megaesophagus, and a history of pre-existing respiratory or neurologic disease. Sixty-nine% of dogs with two or more of the above independent predictive variables developed AP.
Most anesthetic agents and procedures were not associated with the development of AP. We need to devise and evaluate strategies to protect at risk patients.
确定犬麻醉后误吸性肺炎（AP）的发病率，并识别与AP发生相关的麻醉剂、操作及管理因素。
多中心、随机、病例对照回顾性研究。
240只患AP的犬及488只未患病的对照犬。
检索六所兽医学院的电子病历数据库，查找1999年1月至2009年12月期间编码为麻醉或镇静且患肺炎的犬。对所得的2158条记录进行人工检索以确定纳入资格。AP的诊断通过影像学检查。从同一时期接受镇静或麻醉且未发生误吸性肺炎的犬名单中，为每只患病犬随机选取两只未患病对照犬。然后评估57个因素与误吸性肺炎的相关性。数据分析采用单因素卡方检验或学生t检验，然后进行多因素逻辑回归分析。
在10年期间140711例麻醉或镇静病例中，麻醉后AP的发病率为0.17%。与AP发生显著相关的两个麻醉相关事件为反流和诱导时给予氢吗啡酮。给予抗胆碱能药物与AP无关。与误吸性肺炎发生几率增加相关的操作包括剖腹术、上呼吸道手术、神经外科手术、开胸术和内镜检查。骨科手术、眼科手术、牙科手术、MRI、CT、支气管镜检查、膀胱镜检查、气管镜检查和去势与AP的发生无关。三个患者因素与AP的发生相关：巨食管以及既往存在呼吸系统或神经系统疾病史。具有两个或更多上述独立预测变量的犬中有69%发生了AP。
大多数麻醉剂和操作与AP的发生无关。我们需要制定并评估保护高危患者的策略。
