Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Can J Anaesth. 2022 May;69(5):644-657. doi: 10.1007/s12630-022-02199-z. Epub 2022 Feb 2.
Numerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists.
Member society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations that focused on perioperative airway management of patients with proven or potential COVID-19 were included. Accelerated screening was used; data were extracted by one reviewer and verified by a second. Data were organized into themes based on perioperative phase of care.
Thirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed among recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended videolaryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%.
Recommendations for perioperative airway management of patients with COVID-19 overlap to a large extent but also show significant differences. Given the paucity of data early in the pandemic, it is not surprising that identified publications largely reflected expert opinion rather than empirical evidence. We suggest future efforts should promote coordinated responses and provide suggestions for studying and establishing best practices in perioperative patients.
Open Science Framework ( https://osf.io/a2k4u/ ); date created, 26 March 2020.
针对 COVID-19 大流行期间的气道和围手术期管理，已发布了大量指南建议。我们对旨在为麻醉师提供指导的指南进行了识别、综合和比较。
检索了世界麻醉师学会联合会和欧洲麻醉师学会的成员学会网站。纳入了专注于有明确或潜在 COVID-19 患者的围手术期气道管理的建议。采用加速筛选；一位审查员提取数据，另一位审查员进行验证。根据围手术期护理阶段，将数据组织成主题。
确定了 30 套独特的建议。没有一套报告了有系统地搜索或选择要纳入证据的方法。其中 4 套在最初发布后进行了更新。在诱导和气道管理方面，大多数建议尽量减少人员，并由最有经验的麻醉师进行气管插管。在个人防护设备方面，建议具有高度一致性。在讨论气管插管方法的建议中，大多数（96%）建议使用可视喉镜，而在使用纤维支气管镜方面存在分歧。术中，23%建议使用特定的麻醉技术，大多数（63%）建议为 COVID-19 患者使用特定的手术室。术后，少数（33%）讨论了拔管程序，或（40%）讨论了恢复室的护理。27%讨论了非技术因素，10%讨论了对医护人员的心理支持。
COVID-19 患者围手术期气道管理的建议在很大程度上重叠，但也存在显著差异。鉴于大流行早期数据的缺乏，所确定的出版物在很大程度上反映了专家意见而非经验证据，这并不奇怪。我们建议未来的努力应促进协调应对，并为围手术期患者的研究和建立最佳实践提供建议。
开放科学框架（https://osf.io/a2k4u/）；创建日期，2020 年 3 月 26 日。
