Department of Anesthesiology, University of California, San Diego, CA, USA.
Rady Children's Hospital San Diego, San Diego, CA, USA.
Paediatr Anaesth. 2021 Apr;31(4):410-418. doi: 10.1111/pan.14138. Epub 2021 Feb 24.
Several prior studies have demonstrated an association between trisomy 21 and airway-related anesthetic complications. However, there is a paucity of large clinical studies characterizing the airway challenges associated with trisomy 21. In this analysis, we examine anesthetic-related airway complications in children with trisomy 21 and compare our findings to well-matched controls.
A chart review of all general anesthetics occurring between 2011 and 2017 at a single pediatric hospital was performed. Children with trisomy 21 were identified. Matched controls were created using a 1:1 propensity score and controlling for patient sex, patient age, surgical specialty, airway management, and anesthetic induction technique. The primary outcomes were the numbers of difficult intubations and perioperative respiratory adverse events. Secondary outcomes included the number of intubation attempts and the Cormack-Lehane grade in each cohort.
RESULTS/DATA ANALYSIS: A total of 2702 anesthetic records were reviewed. Propensity score matching resulted in adequately matched control groups as indicated by a standard mean difference below 0.2 in each case. Logistic regression analysis between trisomy 21 patients and matched controls demonstrated that the trisomy 21 cohort had a higher incidence of perioperative respiratory adverse events (OR 2.04, 95% CI 1.34-3.09, p = .0008) due largely to a higher incidence of airway obstruction (1.7% vs. 0.2%, p = .0005). The trisomy 21 group had a lower rate of difficult intubation (OR 0.26, 95% CI 0.07-0.91, p = .034). There was no association between trisomy 21 and the number of intubation attempts (RR 0.99, 95% CI 0.88-1.13, p = .92) or Cormack-Lehane grade (RR 0.95, 95% CI 0.87-1.05, p = .35).
The trisomy 21 cohort had an increased incidence of perioperative respiratory adverse events compared to matched controls, largely secondary to a higher rate of obstructed ventilation, but without statistically different rates of laryngospasm, bronchospasm, postextubation stridor, or other desaturation events. Our trisomy 21 cohort had a decreased incidence of difficult intubation. There was no association between trisomy 21 and number of attempts required to successfully place an endotracheal tube or a less favorable CL grade.
Compared to matched controls, children with trisomy 21 have a lower incidence of difficult intubation and a higher incidence of perioperative respiratory adverse events, largely due to increased rate of airway obstruction.
先前有几项研究表明，21 三体与气道相关的麻醉并发症之间存在关联。然而，目前还缺乏大规模的临床研究来描述与 21 三体相关的气道挑战。在这项分析中，我们检查了患有 21 三体的儿童的麻醉相关气道并发症，并将我们的发现与匹配良好的对照组进行了比较。
对 2011 年至 2017 年期间在一家儿科医院进行的所有全身麻醉进行了图表回顾。确定了患有 21 三体的患者。使用 1:1 倾向评分匹配，并控制患者性别、患者年龄、手术专业、气道管理和麻醉诱导技术，创建了匹配对照组。主要结局是困难插管和围手术期呼吸不良事件的数量。次要结局包括每个队列的插管次数和 Cormack-Lehane 分级。
结果/数据分析： 共回顾了 2702 份麻醉记录。在每个病例中，标准均差低于 0.2，表明倾向评分匹配产生了足够匹配的对照组。21 三体患者与匹配对照组之间的逻辑回归分析表明，21 三体组围手术期呼吸不良事件的发生率更高（比值比 2.04，95%置信区间 1.34-3.09，p=0.0008），主要是由于气道阻塞的发生率更高（1.7%比 0.2%，p=0.0005）。21 三体组的困难插管发生率较低（比值比 0.26，95%置信区间 0.07-0.91，p=0.034）。21 三体与插管次数（相对风险 0.99，95%置信区间 0.88-1.13，p=0.92）或 Cormack-Lehane 分级（相对风险 0.95，95%置信区间 0.87-1.05，p=0.35）之间无关联。
21 三体组与匹配对照组相比，围手术期呼吸不良事件的发生率增加，主要是由于通气受阻的发生率较高，但喉痉挛、支气管痉挛、拔管后喘鸣或其他低氧血症事件的发生率无统计学差异。我们的 21 三体组困难插管的发生率较低。21 三体与成功放置气管内导管所需的尝试次数或不太有利的 CL 分级之间无关联。
与匹配对照组相比，21 三体患儿的困难插管发生率较低，围手术期呼吸不良事件发生率较高，主要是由于气道阻塞率增加。
