Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Int J Obstet Anesth. 2021 Feb;45:41-48. doi: 10.1016/j.ijoa.2020.10.012. Epub 2020 Nov 4.
In South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related maternal deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation.
Data from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO <90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO nadir was performed to identify confounding variables associated with, and mediators of, hypoxaemia.
In the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship.
Clinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified.
在南非，妊娠高血压疾病是孕产妇死亡的主要原因。超过 50%的与麻醉相关的孕产妇死亡归因于气道管理并发症。我们比较了有和没有妊娠高血压疾病的产妇在全身麻醉诱导期间发生低氧血症的患病率和危险因素。我们假设妊娠高血压疾病与气管插管期间的饱和度降低有关。
对多中心产科气道管理登记处的 402 例病例进行了数据分析。比较了有和没有妊娠高血压疾病的患者在诱导前发生低氧血症（SpO <90%）的患病率。对 SpO 最低值进行分位数回归，以确定与低氧血症相关的混杂变量和中介变量。
在 402 例病例的队列中，19%的患者发生低氧血症，9%的患者没有高血压（估计风险差异为 10%；95%CI 为 2%至 17%；P=0.005）。分位数回归表明，随着体重指数的增加，与妊娠高血压疾病相关的 SpO 最低值较低。室内空气氧饱和度、Mallampati 分级和插管次数与这种关系有关。
在妊娠高血压疾病患者中，气道管理期间出现临床显著的氧饱和度降低的情况更为常见，而体重指数的增加则使情况更为复杂。还确定了高血压到低氧血症通路中的中间因素。
