Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Br J Anaesth. 2023 Jul;131(1):178-187. doi: 10.1016/j.bja.2023.02.035. Epub 2023 Apr 17.
Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.
We queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.
The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.
Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.
对于气管插管困难的儿童，困难的面罩通气是危险的。我们假设某些体格特征和麻醉因素与那些气管插管也困难的小儿患者面罩通气困难有关。
我们对经历“困难”或“不可能”面罩通气的多中心登记处进行了查询。将面罩通气尝试前已知的患者和病例因素纳入此正则化多变量回归分析中进行考虑。还记录了并发症的发生率、以及放置声门上气道装置的抢救频率和效果。评估了注射神经肌肉阻滞剂后面罩通气质量的变化。
困难面罩通气的发生率为 9%（483/5453 例患者）。婴儿和体重增加的患者、体重低于年龄第 5 百分位数的患者或患有特雷彻·柯林斯综合征、软腭下垂或张口受限的患者更有可能出现面罩通气困难。使用面罩和阿片类药物进行麻醉诱导与降低面罩通气困难的风险相关。“困难”面罩通气的患者并发症发生率明显高于无面罩通气困难的患者。在 71%（96/135）的情况下，声门上气道装置的抢救放置改善了通气。与恶化相比，神经肌肉阻滞剂的给药更常与通气质量的改善或无变化相关，而不是恶化相关。
体格检查中的某些异常应增加对可能出现困难面罩通气的怀疑。在面罩通气困难或不可能的儿童中，应强烈考虑使用声门上气道装置进行抢救。
