Booth Lindsay E, Banyi Norbert, Rose Peter, Karmali Shamir, Stojkova Biljana Jonoska, Anderson Donald W, Butskiy Oleksandr
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251333352. doi: 10.1177/19160216251333352. Epub 2025 May 30.
ImportanceMediastinal goiters can complicate anesthetic management, and although awake bronchoscopic intubation is the gold standard, it is resource-intensive and may be unpleasant for patients. In many centers across North America, patients undergoing thyroidectomy for mediastinal goiters are routinely intubated awake.ObjectiveThis study aimed to evaluate the outcomes of intubation in patients selected for awake versus asleep intubation for thyroidectomy of mediastinal goiters.DesignPRISMA 2020 Checklist for systematic reviews was followed. A search was performed in the Medline, Embase, Web of Science, CINAHL, Scopus, and Cochrane databases. Two independent reviewers performed abstract and full-text review. Data were extracted in duplicate. Study quality was assessed using the JBI Critical Appraisal tool. To account for heterogeneity, a 3-level random-effects model was constructed using the Der Simonian and Laird method with an arcsine transformation.Setting and ParticipantsPatients undergoing thyroidectomy for benign mediastinal goiters.Intervention and ExposuresAwake or asleep intubation.Main Outcome(s) and Measure(s)Rate of failed intubations in asleep intubation and proportion of uncomplicated intubations in asleep and awake populations.ResultsTwelve of 490 identified studies, involving 1002 patients, were included. Three cases of failed intubations were found in the asleep intubation group, with an overall incidence of failed intubation of 0.3%. Meta-analysis demonstrated an overall uncomplicated intubation rate of 91% (95% CI 77%-98%, n = 1002). Subgroup analyses showed a 96% success rate (95% CI 73%-100%, n = 60) for awake intubations and 88% (95% CI 69%-98%, n = 942) for asleep intubations. Further refined analyses showed uncomplicated intubation rates of 98% (95% CI 93%-100%, n = 469) for asleep, and 92% (95% CI 78%-99%, n = 48) for awake groups.Conclusions and RelevanceThe risk of failed intubation in patients with mediastinal goiters remains low, and awake intubation may require more attempts than asleep intubation. Further research with standardized definitions of intubation difficulty is needed.
重要性
纵隔甲状腺肿会使麻醉管理变得复杂，虽然清醒状态下支气管镜插管是金标准，但它资源消耗大，且可能让患者不适。在北美许多中心，因纵隔甲状腺肿接受甲状腺切除术的患者通常在清醒状态下插管。
目的
本研究旨在评估因纵隔甲状腺肿行甲状腺切除术而选择清醒插管与麻醉状态下插管的患者的插管结局。
设计
遵循PRISMA 2020系统评价清单。在Medline、Embase、Web of Science、CINAHL、Scopus和Cochrane数据库中进行检索。两名独立 reviewers 进行摘要和全文评审。数据进行了重复提取。使用JBI批判性评价工具评估研究质量。为了考虑异质性，采用Der Simonian和Laird方法并进行反正弦变换构建了一个三级随机效应模型。
设置和参与者
因良性纵隔甲状腺肿接受甲状腺切除术的患者。
干预和暴露
清醒或麻醉状态下插管。
主要结局和测量指标
麻醉状态下插管失败率以及麻醉和清醒人群中未发生并发症的插管比例。
结果
在490项已识别研究中，有12项涉及1002例患者被纳入。麻醉状态下插管组发现3例插管失败，插管失败的总体发生率为0.3%。荟萃分析显示总体未发生并发症的插管率为91%（95%CI 77%-98%，n = 1002）。亚组分析显示清醒插管成功率为96%（95%CI 73%-100%，n = 60），麻醉状态下插管成功率为88%（95%CI 69%-98%，n = 942）。进一步精细分析显示麻醉状态下未发生并发症的插管率为98%（95%CI 93%-100%，n = 469），清醒组为92%（95%CI 78%-99%，n = 48）。
结论及相关性
纵隔甲状腺肿患者插管失败的风险仍然较低，且清醒插管可能比麻醉状态下插管需要更多尝试。需要对插管困难的标准化定义进行进一步研究。
