Sturm Patrick, Gaessler Holger, Weiß Christel, Schramm Alexander, Wilde Frank, Ebeling Marcel, Sakkas Andreas
Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.
Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital Ulm, Ulm, Germany.
BMC Anesthesiol. 2025 Apr 23;25(1):195. doi: 10.1186/s12871-025-03048-4.
Local tumor-related anatomical changes can complicate the anesthetic airway management of patients with carcinoma of the oral cavity. The aim of this study was to investigate whether there are predictive factors for the occurrence of a difficult airway in this patient cohort and whether a difficult airway influences postoperative outcome. In addition, the influence of an intraoperative tracheostomy on postoperative outcome was to be analyzed.
The treatment records of 201 patients with oral cavity carcinoma who underwent surgery between 2012 and 2023 in a single center were retrospectively analyzed. The definition of difficult airway corresponded to the current S1 guideline of the German Society of Anesthesiology and Intensive Care Medicine from 2015. An association between possible predictive factors and a difficult airway was investigated. The influence of BMI, Mallampati score and Cormack/Lehane score on the number of intubation attempts was analyzed separately. Furthermore, the influence of a difficult airway on the duration of intubation and the duration of the postoperative inpatient stay as well as the postoperative ICU stay was investigated. In addition, the association between an intraoperative tracheostomy and the duration of intubation as well as the duration of the postoperative inpatient stay was analyzed.
Difficult airway occurred in 15 patients (7,5%) and 136 (68%) underwent intraoperative tracheostomy. An indirect laryngoscopy was used in advance in 32,8% of the total patients and 45,4% of the patients undergoing revision surgery. Among the investigated variables, no predictive factors for a difficult airway could be identified. Regarding the number of intubation attempts required, a higher BMI and Mallampati score did not lead to increased number of intubation attempts; however, patients with a Cormack/Lehane score of 3 were significantly more likely to require 2 attempts than patients with a score of 1 or 2 (p = 0.0225). The success rate of first intubation attempt was 78% with videolaryngoscopy, compared to 95,5% when direct laryngoscopy was used (p = 0,0008). A difficult airway did not lead to prolonged postoperative ICU stay and total hospitalisation length. Patients with an intraoperative tracheostomy had a significantly longer mechanical ventilation and total hospitalisation length than patients without (p < 0.0001).
Within the limitations of this study, no patient-specific predictors for a difficult airway were identified in patients with oral cavity carcinoma. Videolaryngoscopy in advance did not increase the success rate of the first intubation attempt compared to direct laryngoscopy. Despite this, videolaryngoscopy may be a preferable approach in this population, especially in patients undergoing revision surgeries. The results highlight the importance of a careful preoperative assessment with clearly defined criteria for a difficult airway and appropriate anaesthesiological preparation to avoid complications during intubation.
Ethics committee of the University of Ulm, approval reference: 115/23, approval date: 08.05.2023.
局部肿瘤相关的解剖结构改变会使口腔癌患者的气道麻醉管理变得复杂。本研究的目的是调查该患者群体中是否存在困难气道发生的预测因素，以及困难气道是否会影响术后结局。此外，还将分析术中气管切开术对术后结局的影响。
回顾性分析了2012年至2023年在单中心接受手术的201例口腔癌患者的治疗记录。困难气道的定义符合德国麻醉与重症医学学会2015年的现行S1指南。研究了可能的预测因素与困难气道之间的关联。分别分析了体重指数（BMI）、马兰帕蒂评分和科马克/莱汉内评分对插管尝试次数的影响。此外，还研究了困难气道对插管持续时间、术后住院时间以及术后重症监护病房（ICU）住院时间的影响。另外，分析了术中气管切开术与插管持续时间以及术后住院时间之间的关联。
15例患者（7.5%）出现困难气道，136例（68%）接受了术中气管切开术。32.8%的患者和45.4%的再次手术患者提前进行了间接喉镜检查。在所研究的变量中，未发现困难气道的预测因素。关于所需的插管尝试次数，较高的BMI和马兰帕蒂评分并未导致插管尝试次数增加；然而，科马克/莱汉内评分为3分的患者比评分为1分或2分的患者需要进行2次尝试的可能性显著更高（p = 0.0225）。视频喉镜检查首次插管尝试的成功率为78%，而直接喉镜检查时为95.5%（p = 0.0008）。困难气道并未导致术后ICU住院时间和总住院时间延长。接受术中气管切开术的患者机械通气时间和总住院时间显著长于未接受气管切开术的患者（p < 0.0001）。
在本研究的局限性内，未在口腔癌患者中确定困难气道的患者特异性预测因素。与直接喉镜检查相比，提前进行视频喉镜检查并未提高首次插管尝试的成功率。尽管如此，视频喉镜检查可能是该人群中更可取的方法，尤其是在再次手术的患者中。结果强调了进行仔细的术前评估以及制定明确的困难气道标准和适当的麻醉准备以避免插管期间并发症的重要性。
乌尔姆大学伦理委员会，批准编号：115/23，批准日期：2023年5月8日。
