Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, niversity of Pennsylvania, Philadelphia, Pennsylvania.
Anesthesiology. 2022 Oct 1;137(4):418-433. doi: 10.1097/ALN.0000000000004353.
Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia.
This study used data from an international observational registry, the Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways. The use of sedation versus general anesthesia for tracheal intubation were compared. The primary outcome was the first-attempt success of tracheal intubation. Secondary outcomes included the number of intubation attempts and nonsevere and severe complications. Propensity score matching was used with a matching ratio up to 1:15 to reduce bias due to measured confounders.
Between 2017 and 2020, 34 hospitals submitted 1,839 anticipated difficult airway cases that met inclusion criteria for the study. Of these, 75 patients received sedation, and 1,764 patients received general anesthesia. Propensity score matching resulted in 58 patients in the sedation group and 522 patients in the general anesthesia group. The rate of first-attempt success of tracheal intubation was 28 of 58 (48.3%) in the sedation group and 250 of 522 (47.9%) in the general anesthesia group (odds ratio, 1.06; 95% CI, 0.60 to 1.87; P = 0.846). The median number of intubations attempts was 2 (interquartile range, 1 to 3) in the sedation group and 2 (interquartile range, 1, 2) in the general anesthesia group. The general anesthesia group had 6 of 522 (1.1%) intubation failures versus 0 of 58 in the sedation group. However, 16 of 58 (27.6%) sedation cases had to be converted to general anesthesia for successful tracheal intubation. Complications were similar between the groups, and the rate of severe complications was low.
Sedation and general anesthesia had a similar rate of first-attempt success of tracheal intubation in children with difficult airways; however, 27.6% of the sedation cases needed to be converted to general anesthesia to complete tracheal intubation. Complications overall were similar between the groups, and the rate of severe complications was low.
在困难气道的成人中，镇静和清醒气管插管方法被认为是最安全的，但对于儿童镇静插管的结果知之甚少。本研究的主要目的是比较镇静气管插管与全身麻醉下气管插管的首次插管成功率。假设是镇静插管的首次尝试成功率会低于全身麻醉，并且并发症更多。
本研究使用了国际观察性登记处——儿科困难插管登记处的数据，该登记处前瞻性地收集了困难气道儿童气管插管的数据。比较了镇静与全身麻醉用于气管插管。主要结局是气管插管的首次尝试成功率。次要结局包括插管尝试次数以及非严重和严重并发症。使用倾向评分匹配，匹配比例最高可达 1:15，以减少因测量混杂因素而导致的偏倚。
2017 年至 2020 年间，34 家医院提交了 1839 例符合研究纳入标准的预计困难气道病例。其中，75 例患者接受了镇静治疗，1764 例患者接受了全身麻醉。倾向评分匹配后，镇静组有 58 例患者，全身麻醉组有 522 例患者。镇静组首次插管成功率为 58 例中的 28 例（48.3%），全身麻醉组为 522 例中的 250 例（47.9%）（比值比，1.06；95%置信区间，0.60 至 1.87；P=0.846）。镇静组插管尝试次数中位数为 2（四分位距，1 至 3），全身麻醉组为 2（四分位距，1，2）。全身麻醉组 522 例中有 6 例（1.1%）插管失败，而镇静组 58 例中无 0 例。然而，58 例镇静病例中有 16 例需要转为全身麻醉才能成功进行气管插管。两组的并发症相似，严重并发症的发生率较低。
在困难气道的儿童中，镇静和全身麻醉的首次尝试气管插管成功率相似；然而，27.6%的镇静病例需要转为全身麻醉才能完成气管插管。两组的并发症总体相似，严重并发症的发生率较低。
