Reale Sharon C, Bauer Melissa E, Klumpner Thomas T, Aziz Michael F, Fields Kara G, Hurwitz Rachel, Saad Manal, Kheterpal Sachin, Bateman Brian T
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Anesthesiology. 2022 May 1;136(5):697-708. doi: 10.1097/ALN.0000000000004173.
Estimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this study were to provide a contemporary estimate of the frequency of difficult and failed intubation in women undergoing general anesthesia for cesarean delivery and to elucidate risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery.
This is a multicenter, retrospective cohort study utilizing the Multicenter Perioperative Outcomes Group database. The study population included women aged 15 to 44 yr undergoing general anesthesia for cesarean delivery between 2004 and 2019 at 1 of 45 medical centers. Coprimary outcomes included the frequencies of difficult and failed intubation. Difficult intubation was defined as Cormack-Lehane view of 3 or greater, three or more intubation attempts, rescue fiberoptic intubation, rescue supraglottic airway, or surgical airway. Failed intubation was defined as any attempt at intubation without successful endotracheal tube placement. The rates of difficult and failed intubation were assessed. Several patient demographic, anatomical, and obstetric factors were evaluated for potential associations with difficult intubation.
This study identified 14,748 cases of cesarean delivery performed under general anesthesia. There were 295 cases of difficult intubation, with a frequency of 1:49 (95% CI, 1:55 to 1:44; n = 14,531). There were 18 cases of failed intubation, with a frequency of 1:808 (95% CI, 1:1,276 to 1:511; n = 14,537). Factors with the highest point estimates for the odds of difficult intubation included increased body mass index, Mallampati score III or IV, small hyoid-to-mentum distance, limited jaw protrusion, limited mouth opening, and cervical spine limitations.
In this large, multicenter, contemporary study of more than 14,000 general anesthetics for cesarean delivery, an overall risk of difficult intubation of 1:49 and a risk of failed intubation of 1:808 were observed. Most risk factors for difficult intubation were nonobstetric in nature. These data demonstrate that difficult intubation in obstetrics remains an ongoing concern.
产科人群中困难插管发生率的估计差异很大，尽管先前报道产科困难插管率的研究年代较久且受样本量较小的限制。本研究的目的是对剖宫产全身麻醉女性中困难插管和插管失败的频率提供当代估计，并阐明剖宫产全身麻醉女性困难插管的危险因素。
这是一项利用多中心围手术期结局组数据库的多中心回顾性队列研究。研究人群包括2004年至2019年期间在45个医疗中心之一接受剖宫产全身麻醉的15至44岁女性。共同主要结局包括困难插管和插管失败的频率。困难插管定义为Cormack-Lehane分级为3级或更高、三次或更多次插管尝试、抢救性纤维支气管镜插管、抢救性声门上气道或手术气道。插管失败定义为任何插管尝试但未成功置入气管导管。评估困难插管和插管失败的发生率。评估了几个患者人口统计学、解剖学和产科因素与困难插管的潜在关联。
本研究确定了14748例在全身麻醉下进行的剖宫产病例。有295例困难插管，频率为1:49（95%CI，1:55至1:44；n = 14531）。有18例插管失败，频率为1:808（95%CI，1:1276至1:511；n = 14537）。困难插管几率点估计最高的因素包括体重指数增加、Mallampati分级III或IV级、舌骨至颏部距离小、下颌前突受限、张口受限和颈椎受限。
在这项对14000多例剖宫产全身麻醉进行的大型、多中心当代研究中，观察到困难插管的总体风险为1:49，插管失败的风险为1:808。大多数困难插管的危险因素本质上是非产科的。这些数据表明产科困难插管仍然是一个持续存在的问题。
