Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Surgical Outcomes Research Centre, University College London, UK.
Anaesthesia. 2023 Jan;78(1):23-35. doi: 10.1111/anae.15851. Epub 2022 Sep 7.
The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.
在 COVID-19 大流行期间，人们认为患者向气道医生传播气溶胶化病毒颗粒的风险很高，因此广泛使用了气溶胶预防措施，包括个人防护设备和对麻醉技术的修改。这些气溶胶预防措施对围手术期气道并发症的风险尚未在模拟研究之外进行评估。本前瞻性、全国性、多中心队列研究旨在量化这种风险。纳入了在 96 小时内接受全身麻醉的择期或急诊手术的成年患者。收集的数据包括气道医生使用的气溶胶预防措施、气道并发症和潜在的混杂变量。混合效应逻辑回归用于评估单个气溶胶预防措施对总体和特定气道并发症的风险。纳入了来自 70 家医院的 5905 名患者的数据。气道并发症的发生率为 10.0%（95%CI 9.2-10.8%）。使用过滤面罩 2 级或 3 级呼吸器与气道并发症的风险增加相关（比值比 1.38，95%CI 1.04-1.83），主要与面罩通气困难（比值比 1.68，95%CI 1.09-2.61）和脉搏血氧饱和度监测下的血氧饱和度下降（比值比 2.39，95%CI 1.26-4.54）相关。使用护目镜、动力空气净化呼吸器、长袖手术服、双层手套和视频喉镜与气道并发症风险的任何改变无关。总体而言，使用过滤面罩 2 级或 3 级呼吸器与气道并发症的风险增加相关，但在 COVID-19 大流行期间使用的大多数气溶胶预防措施并非如此。
