颞下颌关节强直患者围手术期气道管理技术及并发症：来自一家三级护理教学机构的经验

Perioperative airway management techniques and complications in patients with temporomandibular joint ankylosis: Experience from a tertiary care teaching institute.

作者信息

Trikha Anjan, Roychoudhury Ajoy, Goswami Devalina, Maitra Souvik, Bhutia Ongkila, Baidya Dalim Kumar

机构信息

Department of Anesthesiology, Penn State Hershey Medical Center and Penn State College of Medicine, USA.

Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS New Delhi, India.

出版信息

Saudi J Anaesth. 2025 Jan-Mar;19(1):8-13. doi: 10.4103/sja.sja_414_24. Epub 2025 Jan 1.

DOI:10.4103/sja.sja_414_24

PMID:39958302

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11829672/

Abstract

BACKGROUND AND AIMS

Temporomandibular Joint (TMJ) ankylosis patients pose serious anesthetic challenges due to difficult airway and obstructive sleep apnoea (OSA). However, data are sparse on anesthetic management and perioperative outcomes of such patients. This study aimed to identify the anesthetic and airway management techniques in children and adolescents with TMJ ankylosis and whether the presence of retrognathia and OSA increases the risk of airway-related complications.

MATERIALS AND METHODS

A retrospective anesthetic chart review of TMJ ankylosis patients undergoing maxillo-facial surgery from 2008 to 2018 in a tertiary care teaching hospital in India was performed. Available anesthetic data were tabulated and analyzed. Difficult mask ventilation, use of nasopharyngeal airway (NPA), difficult intubation, desaturation at induction and extubation, maneuvers to open the airway at extubation, and any post-operative anesthetic complications were noted.

RESULTS

Three hundred seventy-two children including 85 patients of OSA were available for analysis. All patients with OSA had retrognathia. Fiber-optic bronchoscopy (FOB) guided intubation was performed in 362 (97.3%) patients. Desflurane and fentanyl were common anesthetics used for the maintenance of anesthesia. Difficult mask ventilation, use of nasopharyngeal airway (NPA) and requirement of airway maneuvers were more common in OSA patients than in non-OSA patients. Difficult mask ventilation was observed in 18.0% and difficult intubation in 12.9% of patients. Desaturation at induction was noted in 5.1% of patients but none required emergency surgical airway access. Maneuvres to open the airway at extubation were required in 24.5% of patients and the incidence of desaturation at extubation was 7.2%. However, no serious adverse event was noted and only one patient required reintubation.

CONCLUSION

FOB-guided intubation should be considered the technique of choice in TMJ ankylosis patients. In the presence of retrognathia and OSA chance of difficult mask ventilation, requirement of NPA and difficulty in maintaining the airway after extubation increase significantly.

摘要

背景与目的

颞下颌关节（TMJ）强直患者因气道困难和阻塞性睡眠呼吸暂停（OSA）而面临严重的麻醉挑战。然而，关于此类患者麻醉管理和围手术期结局的数据较为稀少。本研究旨在确定儿童和青少年TMJ强直患者的麻醉和气道管理技术，以及下颌后缩和OSA的存在是否会增加气道相关并发症的风险。

材料与方法

对印度一家三级护理教学医院2008年至2018年接受颌面外科手术的TMJ强直患者的麻醉记录进行回顾性分析。将可用的麻醉数据列表并进行分析，并记录困难面罩通气、鼻咽气道（NPA）的使用、困难插管、诱导和拔管时的血氧饱和度下降、拔管时开放气道的操作以及任何术后麻醉并发症。

结果

共有372名儿童可供分析，其中85名患有OSA。所有OSA患者均有下颌后缩。362例（97.3%）患者采用纤维支气管镜（FOB）引导插管。地氟烷和芬太尼是常用的麻醉维持药物。与非OSA患者相比，OSA患者中困难面罩通气、鼻咽气道（NPA）的使用和气道操作的需求更为常见。18.0%的患者出现困难面罩通气，12.9%的患者出现困难插管。5.1%的患者在诱导时出现血氧饱和度下降，但无人需要紧急手术气道通路。24.5%的患者在拔管时需要开放气道的操作，拔管时血氧饱和度下降的发生率为7.2%。然而，未观察到严重不良事件，只有1例患者需要再次插管。