Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Autor:	Anja F. Koehn, Susanne Sehner, Christian Zöllner, Mark A. Punke, Sebastian Haas, Kurt Ullrich, Thorsten Dohrmann, Nicole Muschol, Katharina Roeher, Sandra Breyer, Martin Petzoldt
Rok vydání:	2020
Předmět:	Adult Male Adolescent medicine.medical_treatment Laryngoscopy Cohort Studies Young Adult Postoperative Complications Mucolipidoses medicine Humans Intubation Anesthesia Airway Management Child Intraoperative Complications Adverse effect Retrospective Studies medicine.diagnostic_test business.industry Tracheal intubation Infant Retrospective cohort study Perioperative Mucopolysaccharidoses Anesthesiology and Pain Medicine Child Preschool Pediatrics Perinatology and Child Health Female Airway management business Airway
Zdroj:	Pediatric Anesthesia. 30:181-190
ISSN:	1460-9592 1155-5645
DOI:	10.1111/pan.13787
Popis:	BACKGROUND Children suffering from mucopolysaccharidoses (subtypes I, II, III, IV, VI, and VII) or mucolipidoses often require anesthesia, but are at high risk for perioperative adverse events. However, the impact of the disease subtype and the standard of care for airway management are still unclear. AIMS This study aimed to assess independent risk factors for perioperative adverse events in individuals with mucopolysaccharidoses/mucolipidoses and to analyze the interaction with the primary airway technique implemented. METHODS This retrospective study included individuals with mucopolysaccharidoses/mucolipidoses who underwent anesthesia at two high-volume centers from 2002 to 2016. The data were analyzed in a multivariate hierarchical model, accounting for repeated anesthesia procedures within the same patient and for multiple events within a single anesthesia. RESULTS Of 141 identified inpatients, 67 (63 mucopolysaccharidoses and 4 mucolipidoses) underwent 269 anesthesia procedures (study cases) for 353 surgical or diagnostic interventions. At least one perioperative adverse event occurred in 25.6% of the cases. The risk for perioperative adverse events was higher in mucopolysaccharidoses type I (OR 8.0 [1.5-42.7]; P = .014) or type II (OR 8.8 [1.3-58.6]; P = .025) than in type III. Fiberoptic intubation through a supraglottic airway was associated with the lowest risk for perioperative adverse events and lowest conversion rate. Direct laryngoscopy was associated with a significantly higher risk for airway management problems than indirect techniques (estimated event rates 47.8% vs 10.1%, OR 24.05 [5.20-111.24]; P
Databáze:	OpenAIRE
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