Year : 2018 | Volume
: 131 | Issue : 6 | Page : 631--637
Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial
Ji-Ming Wang1, Er-Li Ma1, Qing-Ping Wu2, Ming Tian3, Yan-Yan Sun4, Jing Lin1, Liang Peng1, Qiang Xu2, Wei Wei3, Hong Tan3, Cen Yang4, Xiao-Qiang Li1, Yun-Xia Zuo1, Jin Liu1
1 Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
2 Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
3 Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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 (5.81% vs. 36.05%, χ2 = 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%, χ2 = 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.
Trial Registration: No. ChiCTR-TRC-11001418; http://www.gctr.org/cn/proj/show.aspx?proj=1562.
Dr. Yun-Xia Zuo
Department of Anesthesiology and Translational Medical Neuroscience Center, West China Hospital, Sichuan University, Guoxuexiang 37#, Chengdu, Sichuan 610041
|How to cite this article:|
Wang JM, Ma EL, Wu QP, Tian M, Sun YY, Lin J, Peng L, Xu Q, Wei W, Tan H, Yang C, Li XQ, Zuo YX, Liu J. Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial.Chin Med J 2018;131:631-637
|How to cite this URL:|
Wang JM, Ma EL, Wu QP, Tian M, Sun YY, Lin J, Peng L, Xu Q, Wei W, Tan H, Yang C, Li XQ, Zuo YX, Liu J. Effectiveness and Safety of a Novel Approach for Management of Patients with Potential Difficult Mask Ventilation and Tracheal Intubation: A Multi-center Randomized Trial. Chin Med J [serial online] 2018 [cited 2018 Jun 25 ];131:631-637
Available from: http://www.cmj.org/article.asp?issn=0366-6999;year=2018;volume=131;issue=6;spage=631;epage=637;aulast=Wang;type=0