A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation

作者：Joseph Thomas T; Gal Jonathan S; DeMaria Samuel Jr; Lin Hung Mo; Levine Adam I; Hyman Jaime B

来源：Anesthesiology, 2016, 125(1): 105-114.

DOI：10.1097/ALN.0000000000001140

<jats:title>Abstract</jats:title>
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<jats:title>Background</jats:title>
<jats:p>Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure.</jats:p>
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<jats:title>Methods</jats:title>
<jats:p>Anesthetic records from 2007 to 2014 were queried for the performance of an awake intubation. Of the 1,085 awake intubations included for analysis, 1,055 involved the use of a flexible bronchoscope. Each awake intubation case was propensity matched with two controls (1:2 ratio), with similar comorbidities and intubations performed after the induction of anesthesia (n = 2,170). The time from entry into the operating room until intubation was compared between groups. The anesthetic records of all patients undergoing awake intubation were also reviewed for failure and complications.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>The median time to intubation for patients intubated post induction was 16.0 min (interquartile range: 13 to 22) from entrance into the operating room. The median time to intubation for awake patients was 24.0 min (interquartile range: 19 to 31). The complication rate was 1.6% (17 of 1,085 cases). The most frequent complications observed were mucous plug, endotracheal tube cuff leak, and inadvertent extubation. The failure rate for attempted awake intubation was 1% (n = 10).</jats:p>
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<jats:title>Conclusions</jats:title>
<jats:p>Awake intubations have a high rate of success and low rate of serious complications and failure. Awake intubations can be performed safely and rapidly.</jats:p>
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• 出版日期2016-7