Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA.
Curr Opin Anaesthesiol. 2019 Aug;32(4):464-471. doi: 10.1097/ACO.0000000000000760.
This review summarizes key features of adverse airway and respiratory events for which sedation providers must be prepared to diagnose and treat in a timely manner. Key features include elements of the presedation patient evaluation that predict adverse airway and respiratory events; patient profiles, target sedation levels, and procedure types that should prompt a consult with an anesthesiologist; necessary clinical skills, essential equipment, and reversal drugs necessary to manage adverse airway and respiratory events; and a proposed airway rescue pathway that describes a sequence of interventions and prompts to call for help when encountering an adverse airway or respiratory event.
Several studies have reported adverse events from sedation. Although the overall rate can approach 4.5%, the incidence of events associated with severe harm is low (e.g., <0.5%). Some that are most harmful are prolonged ventilatory compromise leading to hypoxic brain injury or death. Inadequate clinical skills that contribute to these poor outcomes include undetected or delayed detection of hypopnea, apnea, and partial or complete airway obstruction, inadequate rescue skills to manage drug-induced ventilatory depression or airway obstruction, and/or a delay or no attempt to call for expert help followed by a timely response and intervention from that expert help.
To improve outcomes in detecting and managing adverse airway and respiratory events, nonanesthesiologists sedation practitioners must be trained in patient selection, monitoring, pharmacology, physiology, and airway management. One gap in sedation training curriculum is a roadmap to use when managing an adverse airway or respiratory events. This review puts forth a suggested airway rescue pathway for nonanesthesiologist sedation practitioners to use as a decision aid during an adverse airway or respiratory event associated with procedural sedation.
本篇综述总结了镇静提供者必须及时诊断和治疗的不良气道和呼吸事件的关键特征。关键特征包括预测不良气道和呼吸事件的预镇静患者评估要素；应促使与麻醉师咨询的患者特征、目标镇静水平和程序类型；管理不良气道和呼吸事件所需的临床技能、必要设备和逆转药物；以及描述遇到不良气道或呼吸事件时干预和寻求帮助的提示的气道抢救路径。
几项研究报告了镇静相关的不良事件。尽管总体发生率接近 4.5%，但与严重伤害相关的事件发生率较低（例如，<0.5%）。一些最有害的事件是导致缺氧性脑损伤或死亡的长时间通气障碍。导致这些不良结局的不足的临床技能包括未检测到或延迟检测到低通气、呼吸暂停和部分或完全气道阻塞、管理药物诱导的通气抑制或气道阻塞的抢救技能不足、以及/或延迟或未尝试寻求专家帮助，随后未能及时得到专家帮助的及时响应和干预。
为了改善不良气道和呼吸事件的检测和管理结果，非麻醉镇静从业者必须接受患者选择、监测、药理学、生理学和气道管理方面的培训。镇静培训课程中的一个空白是管理不良气道或呼吸事件时使用的路线图。本篇综述为非麻醉镇静从业者提出了一个建议的气道抢救路径，作为在与程序镇静相关的不良气道或呼吸事件期间使用的决策辅助。
