Law J Adam, Morris Ian R, Brousseau Paul A, de la Ronde Sylvia, Milne Andrew D
Department of Anesthesia, Dalhousie University, QEII Health Sciences Centre, Halifax, Infirmary Site, 1796 Summer Street, Halifax, NS, B3H 3K9, Canada,
Can J Anaesth. 2015 Jul;62(7):736-44. doi: 10.1007/s12630-015-0387-y. Epub 2015 Apr 24.
Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002-2013) at our institution.
The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling.
Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4(-4) incidence·year(-1); 95% confidence interval [CI]: -3.0(-4) to 3.0(-5); P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidence·year(-1); 95% CI: 0.076 to 0.083; P < 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011-2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation.
At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway.
清醒气管插管是处理预计存在困难气道患者的一种推荐方法。关于清醒插管的实施频率或其使用情况是否随时间变化的数据较少，尤其是随着视频喉镜的日益普及。本回顾性数据库研究旨在确定我院12年期间（2002 - 2013年）手术室中清醒插管的发生率、成功率和并发症以及其他气管插管技术的发生率。
检索加拿大一家三级护理中心使用的麻醉信息管理系统，查找2002 - 2013年期间所有的清醒插管记录。还检索记录以识别在全身麻醉诱导后可能使用的除直接喉镜检查以外的气道处理方法。使用线性回归模型分析12年期间清醒插管发生率和视频喉镜使用情况的变化。
在146,252例全身麻醉下行气管插管的病例中，有1554例（1.06%）为清醒插管。在研究期间，清醒插管率没有显著变化（斜率 -1.4×10⁻⁴发生率·年⁻¹；95%置信区间[CI]：-3.0×10⁻⁴至3.0×10⁻⁵；P = 0.102）。尽管同期视频喉镜的使用显著增加（斜率0.080发生率·年⁻¹；95% CI：0.076至0.083；P < 0.001），特别是从2009年起，清醒插管率仍相对稳定。31例（2%）清醒插管尝试失败。15.7%的成功操作出现了自我报告的并发症。此外，在一个三年的便利样本（2011 - 2013年）中，49名主治医护人员每人的清醒插管率差异很大，每100例全身麻醉下行气管插管的病例中清醒插管次数从0至3.4次不等。
在我们的三级护理中心，尽管视频喉镜的可及性和使用增加，但在2002 - 2013年研究期间，清醒气管插管的使用没有显著变化。看来清醒气管插管在困难气道管理中仍保留着重要且稳定的作用。
