From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.
Anesth Analg. 2019 Jun;128(6):1256-1263. doi: 10.1213/ANE.0000000000004089.
In patients who undergo surgery for oropharyngeal masses, intubation is almost always successful. However, technical aspects of airway management, including bag mask ventilation and oxygenation, may still be difficult. Although rates of airway difficulty and intubation success in these patients have been studied, these data may not reflect difficulty with individual components of the intubation process. We hypothesized that rates of complications with individual elements of the intubation process would not be reflected in the rate of eventual intubation success. To test our hypothesis, we observed the process of airway management and resulting complications with oxygenation and bag mask ventilation in patients with oropharyngeal masses undergoing otorhinolaryngology procedures under general anesthesia.
Forty-four patients with oropharyngeal masses scheduled for surgery were observed during the process of airway management. Observers recorded the number of airway devices used, the overall number of intubation attempts, the number and type of manual maneuvers required during bag mask ventilation, and the incidence of oxygen desaturation. The eventual intubation success rate was also recorded.
All 44 patients (100%; 95% CI, 92%-100%) were successfully intubated. Thirty-six (81.8%) of 44 patients were intubated asleep and 8 (18.2%) of 44 were intubated awake using flexible fiberoptic bronchoscopy. Thirty-one (86.1%) of 36 patients who were intubated asleep received bag mask ventilation before intubation, while the other 5 patients underwent a rapid sequence induction. Twenty-seven (61.4%) of 44 patients (95% CI, 45%-75%) had ≥1 complication during airway management. Ten (23%) of 44 patients (95% CI, 11%-37%) required ≥3 attempts to intubate, 21 (68%) of 31 patients (95% CI, 49%-83%) had difficult mask ventilation, and 15 patients (34%; 95% CI, 20%-50%) experienced desaturation (oxygen saturation measured by pulse oximetry, <95%).
We found that, although all patients were successfully intubated, clinicians frequently encountered complications with both intubation and mask ventilation. These complications required frequent use of additional manual maneuvers during mask ventilation and a high incidence of oxygen desaturation. The difficulty of airway management in patients with oropharyngeal masses may not be effectively assessed by success rate alone.
在接受口咽肿块手术的患者中，插管几乎总是成功的。然而，气道管理的技术方面，包括面罩通气和给氧，可能仍然存在困难。尽管已经研究了这些患者的气道困难和插管成功率，但这些数据可能无法反映插管过程中各个环节的困难程度。我们假设，插管过程中各个环节的并发症发生率不会反映最终插管成功率。为了验证我们的假设，我们观察了在全身麻醉下接受耳鼻喉科手术的口咽肿块患者的气道管理过程，并观察了给氧和面罩通气过程中的并发症和结果。
观察了 44 例口咽肿块患者的气道管理过程。观察者记录了气道设备的使用次数、总的插管尝试次数、面罩通气时所需的手动操作次数和类型，以及氧饱和度降低的发生率。还记录了最终的插管成功率。
所有 44 例患者（100%；95%CI，92%-100%）均成功插管。44 例患者中，36 例（81.8%）在睡眠中插管，8 例（18.2%）在清醒时使用纤维支气管镜插管。36 例睡眠中插管的患者中有 31 例（86.1%）在插管前接受了面罩通气，而其他 5 例患者接受了快速序贯诱导。44 例患者中有 27 例（61.4%）（95%CI，45%-75%）在气道管理过程中发生了≥1 种并发症。44 例患者中有 10 例（23%）（95%CI，11%-37%）需要≥3 次插管尝试，31 例患者中有 21 例（68%）（95%CI，49%-83%）面罩通气困难，15 例患者（34%）（95%CI，20%-50%）出现了低氧血症（脉搏血氧饱和度仪测量的氧饱和度，＜95%）。
尽管所有患者均成功插管，但临床医生在插管和面罩通气过程中经常遇到并发症。这些并发症需要在面罩通气过程中频繁使用额外的手动操作，且氧饱和度降低的发生率较高。口咽肿块患者的气道管理难度不能仅通过成功率来有效评估。
