Liu Feihong, Xi Chunhua, Cui Xu, Wang Guyan
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2022 May 9;15:945-954. doi: 10.2147/RMHP.S354891. eCollection 2022.
Flexible laryngeal mask airways (FLMAs) ventilation have been widely used as airway devices during general anesthesia, especially in otologic surgery. However, the current literature reports that the clinical success and failure rates for FLMA usage are quite different, and there remains a paucity of data regarding factors associated with FLMA failure and complications related to FLMA usage.
To evaluate the success and failure rates of FLMA usage in otologic surgery, the factors associated with FLMA failure and complications related to FLMA usage.
All patients who underwent otologic surgery, including middle ear and mastoid procedures, under general anesthesia at a large tertiary general hospital from 2015 to 2019 were reviewed. The primary outcome was the FLMA failure rate, defined as any airway event requiring device removal and tracheal intubation, including primary and secondary failure. The secondary outcomes were specific clinical factors, including patient sex, age, weight, American Society of Anesthesiologists (ASA) classification, body mass index (BMI) and duration of surgery, which were analyzed as related risk factors.
Among 5557 patients with planned FLMA use, the final success rate was 98.5%. Sixty-seven percent of the failures occurred during initial introduction of the FLMA, 8% occurred after head and neck rotation, and 25% occurred during the procedures. Two independent clinical factors associated with FLMA failure were male sex and age. Respiratory complications were observed in 0.61% of patients, and the rate of severe nerve and tissue damage associated with FLMA use was 0.05.
This study demonstrates a high success rate of 98.5% for FLMA use in adults undergoing otologic surgery with rare adverse airway events and injuries complications. Two independent risk factors require attention and thorough and accurate management is necessary for every clinician.
可弯曲喉罩气道（FLMA）通气已广泛用作全身麻醉期间的气道装置，尤其是在耳科手术中。然而，目前的文献报道FLMA使用的临床成功率和失败率差异很大，关于与FLMA失败相关的因素以及与FLMA使用相关的并发症的数据仍然很少。
评估FLMA在耳科手术中的使用成功率和失败率、与FLMA失败相关的因素以及与FLMA使用相关的并发症。
回顾了2015年至2019年在一家大型三级综合医院接受包括中耳和乳突手术在内的耳科手术的所有全身麻醉患者。主要结局是FLMA失败率，定义为任何需要移除装置并进行气管插管的气道事件，包括初次和二次失败。次要结局是特定的临床因素，包括患者性别、年龄、体重、美国麻醉医师协会（ASA）分级、体重指数（BMI）和手术持续时间，作为相关危险因素进行分析。
在计划使用FLMA的5557例患者中，最终成功率为98.5%。67%的失败发生在初次插入FLMA期间，8%发生在头颈部旋转后，25%发生在手术过程中。与FLMA失败相关且独立的两个临床因素是男性和年龄。0.61%的患者观察到呼吸并发症，与FLMA使用相关的严重神经和组织损伤发生率为0.05。
本研究表明，FLMA在接受耳科手术的成人中使用成功率高达98.5%，气道不良事件和损伤并发症罕见。两个独立的危险因素需要引起注意，每位临床医生都必须进行全面准确的管理。
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