Department of Anesthesiology, Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310000, China.
Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
BMC Anesthesiol. 2023 Apr 27;23(1):141. doi: 10.1186/s12871-023-02099-9.
Children with OSAS are prone to various airway complications during tracheal extubation after tonsillectomy and adenoidectomy due to oropharyngeal secretions and oozing blood. However, few studies have examined the effect of position on airway complications after tracheal extubation in children with OSAS. The aim of this study was to investigate the appropriate position for extubation in children with OASA.
A total of 459 children aged 3-14 years with OSAS who underwent tonsillectomy and adenoidectomy were recruited for this study. All children were treated with the same surgical approach and standard anesthesia methods of induction of anesthesia, tracheal intubation and maintenance of anesthesia. At the end of surgery, the children were delivered to the post anesthesia care unit and randomly divided into three groups: Group A: Head-high 0° in lateral position; Group B: Head-high 15° in lateral position; Group C: Head-high 30° in lateral position. The main outcomes of this study were the pulse oxygen saturation (SpO) and the Sedation-Agitation Scale (SAS) scores of the children after extubation, the outflow of oral-nasal secretions and the respiratory complications. Secondary outcomes were blood pressure, heart rate, end-respiratory carbon dioxide, respiratory rate, and post-operative awakening time of the children in three groups.
Data from a total of 423 children were statistically analyzed, 141 in Group A, 142 in Group B, and 140 in Group C. The main results showed a significant decrease in choking response after extubation in Group B (46.5%) and Group C (40.7%) compared to Group A (60.3%) (P < 0.05). The SAS score for postoperative agitation was higher in Group A (4.6 [Formula: see text] 0.9) than in Group B (4.4 [Formula: see text] 0.7) and Group C (4.3 [Formula: see text] 0.6) (P < 0.05). Also the SpO after extubation was higher in Group B (97.2%) and Group C (97.1%) than in Group A (95.8%) (P < 0.05). In contrast, there was no difference in the occurrence of respiratory complication and postoperative agitation in children between Group B and Group C (all P > 0.05). In addition, there was no difference in the amount of oral-nasal secretions among the children in the three groups (all P > 0.05).
The head-high 15° lateral position and head-high 30° lateral position can reduce the incidence of airway complications and agitation and provide safe and comfortable extubation conditions for children during the peri-extubation period after tonsillectomy and adenoidectomy, which has certain clinical guidance value.
Registration Number: NO.ChiCTR2200055835(20,01,2022) https://www.chictr.org.cn.
由于口咽分泌物和渗血，行扁桃体切除术和腺样体切除术的阻塞性睡眠呼吸暂停低通气综合征（OSAS）患儿在气管拔管后易发生各种气道并发症。然而，很少有研究探讨体位对 OSAS 患儿气管拔管后气道并发症的影响。本研究旨在探讨 OSAS 患儿合适的拔管体位。
本研究共纳入 459 例年龄 3-14 岁的行扁桃体切除术和腺样体切除术的 OSAS 患儿。所有患儿均采用相同的手术入路和标准麻醉方法进行麻醉诱导、气管插管和维持。手术结束时，患儿被送往麻醉后恢复室，并随机分为三组：A 组：头高脚低 0°侧卧位；B 组：头高脚低 15°侧卧位；C 组：头高脚低 30°侧卧位。本研究的主要结局为拔管后患儿的脉搏血氧饱和度（SpO）和镇静躁动评分（SAS）、口鼻腔分泌物流出情况和呼吸并发症。次要结局为三组患儿的血压、心率、呼气末二氧化碳分压、呼吸频率和术后苏醒时间。
共纳入 423 例患儿进行统计学分析，其中 A 组 141 例、B 组 142 例、C 组 140 例。主要结果显示，与 A 组（60.3%）相比，B 组（46.5%）和 C 组（40.7%）患儿拔管后呛咳反应明显减少（P<0.05）。A 组术后躁动的 SAS 评分（4.6 [Formula: see text] 0.9）高于 B 组（4.4 [Formula: see text] 0.7）和 C 组（4.3 [Formula: see text] 0.6）（P<0.05）。此外，B 组（97.2%）和 C 组（97.1%）患儿拔管后的 SpO 高于 A 组（95.8%）（P<0.05）。相反，B 组和 C 组患儿的呼吸并发症和术后躁动发生率差异无统计学意义（均 P>0.05）。此外，三组患儿的口鼻腔分泌物量差异无统计学意义（均 P>0.05）。
头高脚低 15°侧卧位和头高脚低 30°侧卧位可降低气道并发症和躁动的发生率，为扁桃体切除术和腺样体切除术患儿围拔管期提供安全舒适的拔管条件，具有一定的临床指导价值。
注册号：NO.ChiCTR2200055835（2022 年 1 月 20 日）[https://www.chictr.org.cn]。
Zotero 插件
