气管插管与喉罩气道管理下的牙科麻醉：一项荟萃分析。

Airway Complications in Intubated Versus Laryngeal Mask Airway-Managed Dentistry: A Meta-Analysis.

机构信息

Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.

Department of Dental Maxillofacial Sciences, Sunnybrook Sciences Health Centre, University of Toronto, Toronto, Ontario, Canada.

出版信息

Anesth Prog. 2021 Dec 1;68(4):193-205. doi: 10.2344/anpr-68-04-02.

DOI:10.2344/anpr-68-04-02

PMID:34911069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8674849/

Abstract

OBJECTIVE

Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management.

METHODS

A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I2 statistic. Sensitivity and age-subgroup analyses were explored.

RESULTS

Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I2 = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I2 = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I2 = 0%; moderate quality).

CONCLUSION

Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required.

摘要

目的

全身麻醉（GA）期间，如果气道管理不当，可能会发生严重的气道并发症。本荟萃分析调查了比较使用气管内插管或喉罩气道（LMA）进行气道管理的牙科 GA 期间围手术期技术失败和气道并发症（包括缺氧）的随机对照试验。

方法

系统地搜索了电子数据库和灰色文献。独立审查员评估了合格性，进行了数据提取，完成了偏倚风险评估，并通过推荐分级、评估、发展和评估（Grading of Recommendations, Assessment, Development, and Evaluation，GRADE）判断了结果的质量。使用 95%置信区间（CI）计算了气道并发症的风险比（RR）。使用 I2 统计量量化了异质性。探讨了敏感性和年龄亚组分析。

结果

从总共 9076 篇确定的报告中，有 6 项试验被认为符合条件。这些试验的气道管理干预措施是 LMA。除了术后缺氧外，未发现技术失败或气道并发症的效果差异，LMA 使用率降低了风险（RR，0.22；95%CI，0.06-0.77；I2=0%；中等质量）。在儿科分析中也观察到了类似的效果（RR，0.10；95%CI，0.01-0.84；I2=0%；中等质量）。此外，LMA 使用率降低了儿科咽痛的风险（RR，0.08；95%CI，0.04-0.15；I2=0%；中等质量）。