Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial
单位：[1]Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China四川大学华西医院[2]Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China华中科技大学同济医学院附属协和医院[3]Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China临床科室麻醉科麻醉科首都医科大学附属北京友谊医院[4]Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi 710000, China
Background: Patients with potential difficult mask ventilation (DV) and difficult intubation (DI) are often managed with awake intubation, which can be stressful for patients and anesthesiologists. This prospective randomized study evaluated a new approach, fast difficult airway evaluation (FDAE). We hypothesized that the FDAE approach would reduce the need for awake intubation. Methods: After obtaining informed consent, 302 patients with potential DV/DI undergoing elective surgeries were randomly assigned to the FDAE group (Group E) and the control group (Group C). In Group E, patients were gradually sedated, and adequacy of manual mask ventilation during spontaneous breathing was assessed at various sedation levels. Awake intubation was applied in those with inadequate mask ventilation. In Group C, DI was evaluated under local anesthesia. However, the care team could intubate under general anesthesia if the vocal cords were visible. The primary outcome was the rate of awake intubations in both groups and the induction efficiency assessed by the induction time. The secondary outcome was the incidence of serious complications. Results: The rate of awake intubation was significantly lower in Group E than that in Group C (5.810% vs. 36.05%, chi(2) = 42.3, P < 0.001). The induction time was much shorter in Group E than in Group C (11.85 +/- 4.82 min vs. 18.71 +/- 7.85 min, t = 5.39, P < 0.001). There was no significant difference in the incidence of intubation related complications between the two groups. Patients in Group E had a much lower incidence of recall (9.68% vs. 44.90%, chi(2) = 47.68, P < 0.001) of the induction process and higher satisfaction levels than patients in Group C (t = 15.36, P < 0.001). Conclusions: The FDAE significantly reduces the need for awake intubation and improves the efficiency of the intubation process without comprising safety in patients with potential difficult mask ventilation and DI.
基金：
clinical research grant of China Medical Board [10040210243]
第一作者单位：[1]Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
通讯作者：
通讯机构：[1]Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China[*1]Department of Anesthesiology and Translational Medical Neuroscience Center, West China Hospital, Sichuan University, Guoxuexiang 37#, Chengdu, Sichuan 610041, China
推荐引用方式(GB/T 7714)：
Wang Ji-Ming,Ma Er-Li,Wu Qing-Ping,et al.Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial[J].CHINESE MEDICAL JOURNAL.2018,131(6):631-+.doi:10.4103/0366-6999.226897.
APA：
Wang, Ji-Ming,Ma, Er-Li,Wu, Qing-Ping,Tian, Ming,Sun, Yan-Yan...&Liu, Jin.(2018).Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial.CHINESE MEDICAL JOURNAL,131,(6)
MLA：
Wang, Ji-Ming,et al."Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial".CHINESE MEDICAL JOURNAL 131..6(2018):631-+
