Habrial Pierre, Léger Maxime, Costerousse Fabienne, Debiasi Julie, Breheret Renaud, Vacheron Charles-Hervé, Rineau Emmanuel, Lasocki Sigismond
Department of Anaesthesia and Intensive Care, Angers University Hospital, Angers, France.
Department of Otorhinolaryngology-Head and Neck Surgery, Angers University Hospital, Angers, France.
OTO Open. 2022 Jan 5;6(1):2473974X211065015. doi: 10.1177/2473974X211065015. eCollection 2022 Jan-Mar.
Avoiding tracheal intubation by using general anesthesia with spontaneous breathing (GASB) is attractive for upper airway panendoscopy. The aim of this study was to estimate the incidence of adverse events during panendoscopy under GASB and to assess the practices of French anesthesiologists.
Two-phase study: monocentric retrospective study and national survey.
University hospital center.
Patients who underwent a panendoscopy under GASB at the University Hospital of Angers between January 1 and December 31, 2014, were reviewed. Failure of GASB was defined as an episode of hypoxemia (SpO ≤88%) or the need for face mask ventilation with or without tracheal intubation. Then, we sent an electronic survey to all members of the French Society of Anaesthesia and Intensive Care.
Among the 95 included patients, 22 (23%) experienced a failure of GASB: 3 tolerated hypoxemia, 15 had face mask ventilation episodes, and 4 were intubated. Three factors were associated with failure: obesity (odds ratio, 11.94; 95% CI, 3.20-44.64), history of difficult intubation defined as a Cormack score ≥3 (odds ratio, 6.20; 95% CI, 1.51-25.41), and laryngeal tumor (odds ratio, 2.81; 95% CI, 1.04-7.56). Among the 3930 members of the French Society of Anaesthesia and Intensive Care in 2018, 662 (16.8%) responded to the survey. The 2 preferred techniques to perform panendoscopy were intubation (62%) and intravenous sedation with spontaneous breathing (37%).
Although general anesthesia with orotracheal intubation remains the preferred technique for panendoscopy in France, GASB is an attractive alternative with a low failure rate. Risk factors for failure are obesity, history of difficult intubation, and laryngeal tumor.
对上气道全腔镜检查而言，采用自主呼吸全身麻醉（GASB）避免气管插管具有吸引力。本研究旨在评估GASB下全腔镜检查期间不良事件的发生率，并评估法国麻醉医生的操作情况。
两阶段研究：单中心回顾性研究和全国性调查。
大学医院中心。
回顾2014年1月1日至12月31日期间在昂热大学医院接受GASB下全腔镜检查的患者。GASB失败定义为低氧血症发作（SpO₂≤88%）或需要面罩通气，无论是否进行气管插管。然后，我们向法国麻醉与重症监护学会的所有成员发送了电子调查问卷。
在纳入的95例患者中，22例（23%）出现GASB失败：3例耐受低氧血症，15例有面罩通气发作，4例进行了插管。三个因素与失败相关：肥胖（比值比，11.94；95%可信区间，3.20 - 44.64）、困难插管史定义为Cormack评分≥3（比值比，6.20；95%可信区间，1.51 - 25.41）和喉肿瘤（比值比，2.81；95%可信区间，1.04 - 7.56）。在2018年法国麻醉与重症监护学会的3930名成员中，662名（16.8%）回复了调查。进行全腔镜检查的2种首选技术是插管（62%）和静脉镇静自主呼吸（37%）。
尽管经口气管插管全身麻醉在法国仍是全腔镜检查的首选技术，但GASB是一种具有吸引力的替代方法，失败率较低。失败的危险因素是肥胖、困难插管史和喉肿瘤。
