Karlsen Kjetil Andreas Hognestad, Gisvold Sven Erik, Nordseth Trond, Fasting Sigurd
Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway.
Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
Acta Anaesthesiol Scand. 2023 Nov;67(10):1341-1347. doi: 10.1111/aas.14313. Epub 2023 Aug 16.
Awake fibreoptic intubation has been considered a gold standard in the management of the difficult airway. However, failure may cause critical situations. The aim of this study was to investigate the incidence and causes of failed awake fibreoptic intubation at a tertiary care hospital. The study was conducted at St. Olav University Hospital in Trondheim, Norway. Problems occurring during anaesthesia are routinely recorded in the electronic anaesthesia information system (Picis Clinical Solutions Inc.), including difficult intubations. We applied text search on all anaesthesia records between 2011 and 2021 and identified 833 awake fibreoptic intubations. The anaesthesia records were examined to identify failed awake fibreoptic intubations, the cause of failure and how the airway ultimately was secured. Among 233,938 patients who received anaesthesia, 90,397 received tracheal intubation and 833 received awake fibreoptic intubation. Twenty-nine of the procedures failed. In nine patients the failure caused loss of airway control with desaturation and hypoventilation. The major causes of failure were dislodged tube after induction of general anaesthesia (n = 8), patient distress (n = 5), tube not able to pass (n = 5), and airway bleeding (n = 3). The situations were primarily solved using direct laryngoscopy, with or without bougie, or with video laryngoscopy. Tracheostomy was performed in four patients. Awake fibreoptic intubation failed in 3.5% of patients, most often due to dislocation, problems passing the tracheal tube, or patient discomfort. The failure rate was higher than in previous studies.
清醒纤维光导喉镜插管术一直被视为困难气道管理的金标准。然而，插管失败可能会导致危急情况。本研究的目的是调查一家三级护理医院中清醒纤维光导喉镜插管失败的发生率及原因。该研究在挪威特隆赫姆的圣奥拉夫大学医院开展。麻醉过程中出现的问题会常规记录在电子麻醉信息系统（Picis临床解决方案公司）中，包括困难插管情况。我们对2011年至2021年间所有的麻醉记录进行文本搜索，共识别出833例清醒纤维光导喉镜插管病例。对这些麻醉记录进行检查，以确定清醒纤维光导喉镜插管失败的情况、失败原因以及气道最终是如何确保安全的。在233,938例接受麻醉的患者中，90,397例接受了气管插管，833例接受了清醒纤维光导喉镜插管。其中29例操作失败。9例患者因插管失败导致气道控制丧失，出现低氧血症和通气不足。失败的主要原因包括全身麻醉诱导后导管移位（n = 8）、患者烦躁（n = 5）、导管无法通过（n = 5）和气道出血（n = 3）。这些情况主要通过直接喉镜检查解决，可使用或不使用探条，也可使用视频喉镜。4例患者进行了气管切开术。清醒纤维光导喉镜插管在3.5%的患者中失败，最常见的原因是移位、气管导管通过困难或患者不适。该失败率高于以往研究。
