Unit for Research & Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy.
Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
Br J Anaesth. 2021 Jun;126(6):1173-1181. doi: 10.1016/j.bja.2021.02.021. Epub 2021 Apr 1.
Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.
We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.
Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.
The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.
NCT02350348.
新生儿和婴儿在围手术期易发生低氧血症。本研究旨在分析该欧洲队列中与麻醉气管插管相关的干预措施，并确定其临床后果。
我们对新生儿和小婴儿困难气管插管的欧洲多中心观察性试验（新生儿和儿童麻醉实践评估在欧洲[NECTARINE]）进行了二次分析。主要终点是困难插管的发生率及其相关并发症。次要终点是归因于困难气道管理的严重低氧血症的危险因素，以及 30 天和 90 天的结局。
计划进行 4683 例气管插管。定义为两次直接喉镜检查失败的困难气管插管，发生在 266 例儿童（271 例）中，发生率（95%置信区间[CI]）为 5.8%（95%CI，5.1-6.5）。困难插管中 8%的病例出现心动过缓，而 40%的病例出现明显的氧饱和度下降（SpO<90%持续 60 秒）。在合并症、手术或麻醉管理方面，未发现任何相关的危险因素。使用倾向评分来调整混杂因素，困难的麻醉气管插管不会导致 30 天和 90 天发病率或死亡率增加。
本研究结果表明，60 周龄以下儿童的困难气管插管发生率较高，通常导致严重低氧血症。令人欣慰的是，困难插管的发生并未增加 30 天和 90 天的发病率和死亡率。
NCT02350348。
