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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry
Anesthesiology, Volume 137, No. 4, Year 2022
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Description
Background: Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia. Methods: This study used data from an international observational registry, the Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways. The use of sedation versus general anesthesia for tracheal intubation were compared. The primary outcome was the first-attempt success of tracheal intubation. Secondary outcomes included the number of intubation attempts and nonsevere and severe complications. Propensity score matching was used with a matching ratio up to 1:15 to reduce bias due to measured confounders. Results: Between 2017 and 2020, 34 hospitals submitted 1,839 anticipated difficult airway cases that met inclusion criteria for the study. Of these, 75 patients received sedation, and 1,764 patients received general anesthesia. Propensity score matching resulted in 58 patients in the sedation group and 522 patients in the general anesthesia group. The rate of first-attempt success of tracheal intubation was 28 of 58 (48.3%) in the sedation group and 250 of 522 (47.9%) in the general anesthesia group (odds ratio, 1.06; 95% CI, 0.60 to 1.87; P = 0.846). The median number of intubations attempts was 2 (interquartile range, 1 to 3) in the sedation group and 2 (interquartile range, 1, 2) in the general anesthesia group. The general anesthesia group had 6 of 522 (1.1%) intubation failures versus 0 of 58 in the sedation group. However, 16 of 58 (27.6%) sedation cases had to be converted to general anesthesia for successful tracheal intubation. Complications were similar between the groups, and the rate of severe complications was low. Conclusions: Sedation and general anesthesia had a similar rate of first-attempt success of tracheal intubation in children with difficult airways; however, 27.6% of the sedation cases needed to be converted to general anesthesia to complete tracheal intubation. Complications overall were similar between the groups, and the rate of severe complications was low. © 2022 Lippincott Williams and Wilkins. All rights reserved.
Authors & Co-Authors
Zhang, Bingqing
United States, Philadelphia
University of Pennsylvania
von Ungern-Sternberg, Britta S.
Australia, Perth
Perth Children's Hospital
Whyte, Simon David
Canada, Vancouver
Bc Children's Hospital
Yang, Lei
China, Chengdu
Sichuan University
Echeverry Marín, Piedad Cecilia
Unknown Affiliation
Pérez-Pradilla, Carolina
Unknown Affiliation
Koka, Rahul
United States, Baltimore
Johns Hopkins University
Richtsfeld, Martina
United States, Minneapolis
University of Minnesota Twin Cities
Belani, Kumar G.
United States, Minneapolis
University of Minnesota Twin Cities
de Graaff, J. C.
Netherlands, Rotterdam
Erasmus Mc
Bhalla, Tarun
United States, Columbus
Nationwide Children’s Hospital
Stricker, Paul A.
United States, Philadelphia
The Children's Hospital of Philadelphia
Nishisaki, Akira
United States, Philadelphia
The Children's Hospital of Philadelphia
Watkins, Scott Christopher
United States, Nashville
Vanderbilt University School of Medicine
Olomu, Patrick Nduyari
United States, Dallas
Ut Southwestern Medical Center
Olutoye, Olutoyin A.
United States, Houston
Texas Children's Hospital
Bösenberg, Adrian Thomas
United States, Seattle
Seattle Children's Hospital
Low, Daniel King Wai
United States, Seattle
Seattle Children's Hospital
Statistics
Citations: 9
Authors: 18
Affiliations: 40
Identifiers
Doi:
10.1097/ALN.0000000000004353
ISSN:
00033022
Research Areas
Maternal And Child Health
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative