Heinrich Sebastian, Ackermann Andreas, Prottengeier Johannes, Castellanos Ixchel, Schmidt Joachim, Schüttler Jürgen
Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany.
Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany.
J Cardiothorac Vasc Anesth. 2015 Dec;29(6):1537-43. doi: 10.1053/j.jvca.2015.04.027. Epub 2015 May 5.
Former analyses reported an increased rate of poor direct laryngoscopy view in cardiac surgery patients; however, these findings frequently could be attributed to confounding patient characteristics. In most of the reported cardiac surgery cohorts, the rate of well-known risk factors for poor direct laryngoscopy view such as male sex, obesity, or older age, were increased compared with the control groups. Especially in the ongoing debate on anesthesia staff qualification for cardiac interventions outside the operating room a detailed and stratified risk analysis seems necessary.
Retrospective, anonymous, propensity score-based, matched-pair analysis.
Single-center study in a university hospital.
No active participants. Retrospective, anonymous chart analysis.
The anesthesia records of patients undergoing cardiac surgery in a period of 6 consecutive years were analyzed retrospectively. The results were compared with those of a control group of patients who underwent general surgery. Poor laryngoscopic view was defined as Cormack and Lehane classification grade 3 or 4.
The records of 21,561 general anesthesia procedures were reviewed for the study. The incidence of poor direct laryngoscopic views in patients scheduled for cardiac surgery was significantly increased compared with those of the general surgery cohort (7% v 4.2%). Using propensity score-based matched-pair analysis, equal subgroups were generated of each surgical department, with 2,946 patients showing identical demographic characteristics. After stratifying for demographic characteristics, the rate of poor direct laryngoscopy view remained statistically significantly higher in the cardiac surgery group (7.5% v 5.7%).
Even with stratification for demographic risk factors, cardiac surgery patients showed a significantly higher rate of poor direct laryngoscopic view compared with general surgery patients. These results should be taken into account for human resource management and distribution of difficult airway equipment, especially when cardiac interventional programs are implemented in remote hospital locations.
既往分析报告称心脏手术患者直接喉镜检查视野不佳的发生率增加；然而，这些结果往往可归因于混杂的患者特征。在大多数已报告的心脏手术队列中，与对照组相比，直接喉镜检查视野不佳的知名风险因素（如男性、肥胖或高龄）的发生率有所增加。特别是在关于手术室以外心脏介入手术麻醉人员资质的持续辩论中，详细的分层风险分析似乎很有必要。
回顾性、匿名、基于倾向评分的配对分析。
大学医院的单中心研究。
无主动参与者。回顾性、匿名病历分析。
对连续6年接受心脏手术患者的麻醉记录进行回顾性分析。将结果与接受普通外科手术的对照组患者的结果进行比较。喉镜检查视野不佳定义为Cormack和Lehane分级3级或4级。
本研究共回顾了21,561例全身麻醉手术记录。与普通外科队列相比，心脏手术患者直接喉镜检查视野不佳的发生率显著增加（7%对4.2%）。采用基于倾向评分的配对分析，为每个外科科室生成了相等的亚组，2,946例患者具有相同的人口统计学特征。在对人口统计学特征进行分层后，心脏手术组直接喉镜检查视野不佳的发生率在统计学上仍显著更高（7.5%对5.7%）。
即使对人口统计学风险因素进行分层，心脏手术患者直接喉镜检查视野不佳的发生率仍显著高于普通外科患者。在进行人力资源管理和分配困难气道设备时应考虑这些结果，尤其是在偏远医院实施心脏介入项目时。
