Camporesi Anna, Roveri Giulia, Vetrugno Luigi, Buonsenso Danilo, De Giorgis Valentina, Costanzo Sara, Pierucci Ugo Maria, Pelizzo Gloria
Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy.
Department of Anesthesia and Intensive Care Medicine "F. Tappeiner" Hospital, Merano, Italy.
J Anesth Analg Crit Care. 2024 Oct 5;4(1):69. doi: 10.1186/s44158-024-00206-x.
Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).
This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.
Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21-8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.
Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.
ClinicalTrials.gov identifier: NCT06069414.
肺不张是接受全身麻醉的儿科患者中一种有充分文献记载的并发症。其发生率因手术操作和麻醉技术的不同而有显著差异。与静脉诱导相比，常用于避免静脉穿刺不适的吸入诱导被怀疑会导致包括肺不张在内的更高的呼吸系统并发症发生率。本研究旨在通过肺部超声（LUS）评估吸入麻醉诱导与静脉麻醉诱导对儿科患者肺不张形成的影响。
这项倾向评分匹配的观察性研究在意大利米兰的一家三级儿科医院进行。纳入标准为年龄≤18岁接受全身麻醉择期手术的儿童。患者分为吸入诱导组和静脉诱导组。在麻醉诱导前后进行LUS以评估肺通气情况。主要终点是诱导后LUS全球评分，次要终点包括肺不张的发生率和分布情况。
在纳入的326例患者中，65%接受吸入诱导，35%接受静脉诱导。吸入组的LUS全球评分显著更高（12.0对4.0，p<0.001）。在进行倾向评分匹配（针对年龄、上呼吸道感染情况、诱导持续时间和诱导时的呼气末正压水平）后，面罩诱导的平均治疗效果（ATE）在LUS全球评分上为5.89（95%CI，3.21 - 8.58；p<0.001）分，肺不张的系数为0.35（OR 1.41）。
即使在对临床相关协变量进行调整后，吸入诱导在儿科患者中仍与更高的肺不张发生率相关。
ClinicalTrials.gov标识符：NCT06069414。
