Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain.
Hospital Clínic de Barcelona, Neurology Department, Barcelona, Spain.
Braz J Anesthesiol. 2021 Jul-Aug;71(4):408-412. doi: 10.1016/j.bjane.2021.04.008. Epub 2021 Apr 26.
We aimed to assess the feasibility of using supraglottic devices as an alternative to orotracheal intubation for airway management during anesthesia for endovascular treatment of unruptured intracranial aneurisms in our department over a nine-year period.
Retrospective single center analysis of cases (2010-2018). Primary outcomes: airway management (supraglottic device repositioning, need for switch to orotracheal intubation, airway complications).
aneurysm complexity, history of subarachnoid hemorrhage, hemodynamic monitoring, and perioperative complications.
We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%). No adverse incidents were recorded in 97% of the cases. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Two patients in each group died during early postoperative recovery. Two in each group also had intraoperative bleeding. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%).
Supraglottic device, like other less invasiveness protocols, can be considered a feasible alternative airway management approach in selected patients proposed for endovascular treatment of unruptured intracranial aneurisms.
我们旨在评估在过去九年中，我们科室在对未破裂颅内动脉瘤进行血管内治疗的麻醉过程中，使用声门上设备替代或经口气管插管进行气道管理的可行性。
回顾性分析 2010 年至 2018 年期间的病例（单中心研究）。主要结局：气道管理（声门上设备重新定位、需要更换为经口气管插管、气道并发症）。
动脉瘤复杂性、蛛网膜下腔出血史、血流动力学监测和围手术期并发症。
我们将 187 例患者分为两组：声门上设备组 130 例（69.5%）和经口气管插管组 57 例（30.5%）。97%的病例未发生不良事件。3 例声门上设备患者需要重新定位声门上设备，1 例声门上设备患者因通气不足需要经口气管插管。3 例经口气管插管患者在苏醒时发生支气管痉挛或喉痉挛。45 例（24.1%）患者的动脉瘤复杂或有蛛网膜下腔出血史。其中 33 例（73.3%）需要经口气管插管，而非复杂动脉瘤组的 142 例中有 24 例（16.9%）需要经口气管插管。两组各有 2 例患者在术后早期恢复期间死亡。两组各有 2 例患者在术中发生出血。事后分析显示，2010 年至 2014 年期间有 55 例（44%）患者使用经口气管插管，2015 年至 2018 年期间仅 2 例（3.2%）患者使用经口气管插管，同期内从 2010 年至 2018 年，从 34 例（27.2%）到 5 例（8.2%），血压监测的侵入性也呈逐渐降低的趋势。
与其他微创性方案一样，声门上设备可被视为一种在选择的拟行血管内治疗未破裂颅内动脉瘤的患者中，可行的气道管理替代方案。
