Tang Zhi-Hang, Chen Qi, Huang Wei, Wang Jia-Nan, Zou Xiao-Hua, Xiao Yang, Shi Xiao-Tong, Deng Hai-Hong, Li Jing-Jing, Wu Lun, Liu Wen-Zhi, Hu Si-Guang, Zhou Zheng-Yang, Qi Heng-Ning, Luan Guo-Hui, Luo Wei, Wang Yong, Ma Wu-Hua
Department of Anaesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China.
Department of Anaesthesiology, Chongqing university cancer hospital, Chongqing, China.
J Clin Anesth. 2025 Mar;102:111766. doi: 10.1016/j.jclinane.2025.111766. Epub 2025 Jan 29.
Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.
A multicenter observational cross-sectional study.
This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.
In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.
Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.
This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.
In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.
The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.
困难气道管理是临床麻醉、重症监护和急诊医学中的一项重大挑战。管理不当可能导致包括器官损伤和死亡在内的严重并发症。本研究评估了中国各地困难气道管理的差异，并重点关注患者和操作者因素如何影响手术室的结局。
一项多中心观察性横断面研究。
本研究于2022年11月至2023年11月进行，纳入了中国不同地区的25家二级和三级医院。
在总共181399例全身麻醉患者中，384例（0.21%）被确定为存在困难气道。
通过一份包含四个部分、27个问题的专门问卷收集数据，并在SPSS中使用逻辑回归进行分析，以确定影响困难气道有效管理的关键因素。
本研究重点关注麻醉医生在困难气道管理实践中的术前评估、麻醉选择、插管尝试和应急计划。
在预期的困难气道中，51.7%的病例采用快速顺序诱导，11.1%的病例在全身麻醉下维持自主呼吸，36%的病例采用清醒插管。对于意外的困难气道，95.9%的麻醉医生选择快速顺序诱导。张口受限是困难气道最常见的原因，肥胖和强直性脊柱炎被确定为重要因素。逻辑回归分析确定困难气道类型、麻醉医生经验和评估方法是影响首次插管成功的关键因素。
困难气道评估的准确性和首次插管成功率受患者相关因素和麻醉医生专业知识的影响。决策和工具选择的地区和机构差异凸显了在中国不同临床环境中制定标准化指南和进行全面培训以提高气道管理结局的迫切需求。
