Koo Chang-Hoon, Lee Sun Young, Chung Seung Hyun, Ryu Jung-Hee
Department of Anesthesiology & Pain medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
Department of Anesthesiology & Pain medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea.
J Clin Med. 2018 Oct 14;7(10):353. doi: 10.3390/jcm7100353.
The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172). Electronic databases were searched, without discrimination of publication year and language, to identify all randomized controlled trials investigating airway complications following deep or awake extubation after general anesthesia. The Cochrane tool was used to assess the risk of bias of trials. Randomized trials investigating airway complications of deep extubation compared with awake extubation after general anesthesia with an endotracheal tube and laryngeal mask airway (LMA) were sought. Overall airway complications, airway obstruction, cough, desaturation, laryngospasm and breath holding were analyzed using random-effect modelling. The odds ratio was used for these incidence variables. Seventeen randomized trials were identified, and a total of 1881 pediatric patients were enrolled. The analyses indicated deep extubation reduces the risk of overall airway complications (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33⁻0.96, = 0.04), cough (OR 0.30, 95% CI 0.12⁻0.72, = 0.007) and desaturation (OR 0.49, 95% CI 0.25⁻0.95, = 0.04) in children after general anesthesia. However, deep extubation increased the risk of airway obstruction compared with awake extubation (OR 3.38 CI 1.69⁻6.73, = 0.0005). No difference was observed in the incidence of laryngospasm and breath-holding between the two groups regardless of airway device. The result of this analysis indicates that deep extubation may decrease the risk of overall airway complications including cough and desaturation but may increase airway obstruction compared with awake extubation in pediatric patients after general anesthesia. Therefore, deep extubation may be recommended in pediatric patients to minimize overall airway complications except airway obstruction and the clinicians may choose the method of extubation according to the risk of airway complications of pediatric patients.
本研究的目的是比较全身麻醉后小儿患者在深度麻醉下拔管（深麻醉下拔管）与完全清醒时拔管（清醒拔管）气道并发症的发生率。按照系统评价和Meta分析的首选报告项目（PRISMA）声明标准进行系统评价。该评价方案已在国际前瞻性系统评价注册库注册（注册号：CRD 42018090172）。检索电子数据库，不区分出版年份和语言，以识别所有调查全身麻醉后深麻醉下或清醒拔管后气道并发症的随机对照试验。使用Cochrane工具评估试验的偏倚风险。寻找比较全身麻醉后气管插管和喉罩气道（LMA）深麻醉下拔管与清醒拔管气道并发症的随机试验。使用随机效应模型分析总体气道并发症、气道梗阻、咳嗽、血氧饱和度下降、喉痉挛和屏气。这些发生率变量采用比值比。共识别出17项随机试验，纳入小儿患者共1881例。分析表明，深麻醉下拔管可降低全身麻醉后小儿患者总体气道并发症（比值比（OR）0.56，95%置信区间（CI）0.33⁻0.96，P = 0.04）、咳嗽（OR 0.30，95%CI 0.12⁻0.72，P = 0.007）和血氧饱和度下降（OR 0.49，95%CI 0.25⁻0.95，P = 0.04）的风险。然而，与清醒拔管相比，深麻醉下拔管增加了气道梗阻的风险（OR 3.38，CI 1.69⁻6.73，P = 0.0005）。无论气道装置如何，两组喉痉挛和屏气的发生率均无差异。该分析结果表明，与全身麻醉后小儿患者清醒拔管相比，深麻醉下拔管可能降低包括咳嗽和血氧饱和度下降在内的总体气道并发症风险，但可能增加气道梗阻风险。因此，对于小儿患者，除气道梗阻外，为尽量减少总体气道并发症，可推荐深麻醉下拔管，临床医生可根据小儿患者气道并发症风险选择拔管方法。
