From the Bolyai Institute, University of Szeged, Szeged, Hungary (KV), Département d'Anesthésie-Réanimation, Hôpital Armand Trousseau, Hôpitaux Universitaires Paris Est, Assistance Publique Hôpitaux de Paris, Paris, France (NS), Department of Anaesthesia, Great Ormond Street Hospital, London, UK (MT), Département d'Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, Lille, France (FV) and Department of Anaesthesia, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland (WH).
Eur J Anaesthesiol. 2019 Mar;36(3):185-193. doi: 10.1097/EJA.0000000000000951.
Ear, nose and throat (ENT) surgery, the most frequently performed surgical procedure in children, is a strong predictor for peri-operative respiratory complications. However, there is no clear information about peri-operative respiratory severe critical events (SCEs) associated with anaesthesia management of ENT children in Europe.
To characterise the epidemiology and incidence of respiratory SCEs during and following ENT surgery in Europe and to identify the risk factors for their occurrence.
A secondary analysis of the Anaesthesia PRactice In Children Observational Trial, a prospective observational multicentre cohort trial.
The study included 261 centres across 33 European countries and took place over a consecutive 2-week recruitment period between April 2014 and January 2015.
We extracted data from 5592 ENT surgical procedures that were performed on 5572 children aged 6.0 (3.6) years (mean (SD)) from the surgical database and compared these with data from 15 952 non-ENT surgical children aged 6.7 (4.8) years.
The primary outcome was the incidence of respiratory SCEs (laryngospasm, bronchospasm and new onset of postoperative stridor). Secondary outcomes were the differences in epidemiology between ENT children and non-ENT surgical children and the risk factors for the occurrence of respiratory SCEs.
The incidence (95% confidence interval) of any respiratory SCE (laryngospasm, bronchospasm and postoperative stridor) was 3.93% (3.46 to 4.48) and was significantly higher than that observed in non-ENT surgical children [2.61% (2.37 to 2.87)], with a relative risk of 1.51 (1.28 to 1.77), P less than 0.0001. Younger age (14% decrease in critical events by increasing year, P < 0.0001), history of snoring, recent upper respiratory tract infection and recent wheezing increased the risk of suffering a SCE by over two-fold (P < 0.0001). There was also some evidence for a positive association with age below 4.6 years and lower surgical volume thresholds (<20 cases/2 weeks).
The results of this study provide additional evidence for strong associations between risk factors and respiratory SCEs in children having ENT surgery. These observations may facilitate the implementation of good clinical practice recommendations for ENT patients in Europe.
ClinicalTrials.gov, number NCT01878760.
耳鼻喉（ENT）手术是儿童最常进行的手术，是围手术期呼吸并发症的强烈预测指标。然而，在欧洲，尚无有关 ENT 儿童麻醉管理相关围手术期严重呼吸不良事件（SCE）的明确信息。
描述欧洲 ENT 手术期间和之后与麻醉管理相关的 SCE 的流行病学和发生率，并确定其发生的危险因素。
对 Anaesthesia PRactice In Children Observational Trial（儿童麻醉实践观察性试验）进行二次分析，这是一项前瞻性观察性多中心队列研究。
该研究纳入了欧洲 33 个国家的 261 个中心，于 2014 年 4 月至 2015 年 1 月连续 2 周招募患者。
我们从手术数据库中提取了 5572 名 6.0（3.6）岁（均值（SD））儿童的 5592 例 ENT 手术数据，并与 15952 名年龄为 6.7（4.8）岁的非 ENT 手术儿童的数据进行了比较。
主要结局为呼吸 SCE （喉痉挛、支气管痉挛和新发性术后喘鸣）的发生率。次要结局为 ENT 患儿与非 ENT 手术患儿之间的流行病学差异，以及发生呼吸 SCE 的危险因素。
任何呼吸 SCE（喉痉挛、支气管痉挛和术后喘鸣）的发生率（95%置信区间）为 3.93%（3.46 至 4.48），明显高于非 ENT 手术患儿[2.61%（2.37 至 2.87）]，相对风险为 1.51（1.28 至 1.77），P 小于 0.0001。年龄较小（每增加 1 岁，严重事件减少 14%，P<0.0001）、打鼾史、近期上呼吸道感染和近期喘息史使发生 SCE 的风险增加两倍以上（P<0.0001）。年龄小于 4.6 岁和手术量较低（<20 例/2 周）也与 SCE 呈正相关。
本研究结果为 ENT 手术患儿的危险因素与呼吸 SCE 之间的强烈关联提供了额外证据。这些观察结果可能有助于为欧洲的 ENT 患者实施良好的临床实践建议。
ClinicalTrials.gov，编号 NCT01878760。
