Bowman J Patrick, Nedley Michael P, Jenkins Kimberly A, Fahncke Charles R
Private Practice Pediatric Dentistry Bowling Green, Ohio.
Assistant Professor and Director Advanced Education in Pediatric Dentistry, Department of Surgery, Division of Dentistry, University of Toledo Medical Center, Toledo, Ohio.
Anesth Prog. 2018 Summer;65(2):89-93. doi: 10.2344/anpr-65-02-07.
The purpose of this article was to determine if pediatric dental treatment under general anesthesia utilizing orotracheal intubation takes longer than using nasotracheal intubation techniques. Twenty-six American Society of Anesthesiologists Physical Status Classification I and II pediatric dental patients, ages 2-8 years treated under general anesthesia, were assigned to 1 of 2 groups: (a) nasotracheal intubation (control, n = 13), (b) orotracheal intubation (experimental, n = 13). Times for intubation, radiographic imaging, and dental procedures, as well as total case time were quantified. Data were collected on airway difficulty, numbers of providers needed for intubation, intubation attempts, and intubation trauma. There was a significant difference in mean intubation time (oral = 2.1 minutes versus nasal = 6.3 minutes; p < .01). There was no difference in mean radiograph time (oral = 4.2 minutes versus nasal = 3.4 minutes; p = .144), and overall radiograph image quality was not affected. There was no difference in dental procedure time ( p = .603) or total case time ( p = .695). Additional providers were needed for intubation and more attempts were required for nasotracheal intubation versus orotracheal intubation (6 additional providers/22 attempts vs 0 additional providers/15 attempts, p < .01 and p < .05, respectively). Nine of 13 nasotracheal intubations were rated as traumatic (69%) versus 0 of 13 for orotracheal intubations (0%) ( p < .01). In 7/9 orotracheal intubation cases (78%), the tube was not moved during treatment ( p < .01). Orotracheal intubation does not increase case time, does not interfere with radiographic imaging, and is less traumatic for the patient when performed by physician anesthesiologists, emergency and pediatric medicine physician residents, certified registered nurse anesthetists, and student nurse anesthetists, all with variable nasotracheal intubation experience.
本文的目的是确定在全身麻醉下采用经口气管插管的儿童牙科治疗是否比使用经鼻气管插管技术耗时更长。26名年龄在2至8岁、美国麻醉医师协会身体状况分级为I级和II级的接受全身麻醉治疗的儿童牙科患者被分为两组之一：(a)经鼻气管插管（对照组，n = 13），(b)经口气管插管（试验组，n = 13）。对插管、影像学检查和牙科手术的时间以及总病例时间进行了量化。收集了气道困难情况、插管所需医护人员数量、插管尝试次数和插管创伤的数据。平均插管时间存在显著差异（经口 = 2.1分钟，经鼻 = 6.3分钟；p <.01）。平均影像学检查时间无差异（经口 = 4.2分钟，经鼻 = 3.4分钟；p =.144），且总体影像学图像质量未受影响。牙科手术时间（p =.603）或总病例时间（p =.695）无差异。与经口气管插管相比，经鼻气管插管需要更多的医护人员协助且尝试次数更多（分别为额外6名医护人员/22次尝试与0名额外医护人员/15次尝试，p <.01和p <.05）。13例经鼻气管插管中有9例被评为有创伤（69%），而13例经口气管插管中无1例有创伤（0%）（p <.01）。在7/9例经口气管插管病例（78%）中，治疗期间导管未移动（p <.01）。当由麻醉医师、急诊和儿科医学住院医师、注册护士麻醉师以及实习护士麻醉师进行操作时，经口气管插管不会增加病例时间，不干扰影像学检查，并且对患者的创伤较小，所有这些人员均有不同程度的经鼻气管插管经验。
