Airway management in general anesthesia for endovascular treatment of cerebral arteriovenous malformation: a retrospective observational study
Manejo das vias aéreas em anestesia geral para tratamento endovascular de malformação arteriovenosa cerebral: um estudo observacional retrospectivo
Mehmet Anıl Süzer, Mehmet Özgür Özhan, Ceyda Özhan Çaparlar, Mehmet Burak Eşkin, Bülent Atik
Abstract
Background and objective: This retrospective and observational study aimed to retrospectively evaluate the use of the endotracheal tube (ETT) and the Laryngeal Mask Airway (LMA) for the airway management with respect to airway safety, hemodynamic stability, adverse respiratory events, and recovery characteristics in patients who underwent endovascular treatment (EVT) for cerebrovascular arteriovenous malformation under general anesthesia between 2011 and 2018.
Methods: The study included data from the patient’s electronic medical records and anesthesia files. The primary outcome measure was the incidence of hemodynamic disturbances and respiratory adverse events during airway management. The secondary outcome measure was the comparison of recovery characteristics.
Results: The airway was secured using ETT in 41 patients and LMA in 39 patients. Airway safety was established in all patients without a complication throughout the procedure. Mean arterial blood pressure and heart rate were increased to > 20% of baseline levels at intubation and extubation periods in more patients in the ETT group than the LMA group (27 vs. 3; p = 0.07, and 11 vs. 2; p = 0.021). Respiratory adverse events including straining and coughing were observed in ten patients in the ETT group but only in one patient in the LMA group (p = 0.013). Time to extubation, to neurological assessment, and to discharge from the angiography unit were similar (p > 0.05).
Keywords
Resumo
Justificativa e objetivo: Este estudo retrospectivo e observacional teve como objetivo avaliar retrospectivamente o uso do tubo endotraqueal (TET) e da máscara laríngea (ML) para o manejo das vias aéreas no que diz respeito à segurança das vias aéreas, estabilidade hemodinâmica, eventos respiratórios adversos e características de recuperação em pacientes submetidos a tratamento endovascular para malformação arteriovenosa cerebrovascular sob anestesia geral entre 2011 e 2018. Métodos: O estudo incluiu dados do prontuário eletrônico do paciente e arquivos de anestesia. A medida do desfecho primário foi a incidência de distúrbios hemodinâmicos e eventos respiratórios adversos durante o manejo das vias aéreas. A medida do desfecho secundário foi a comparação das características de recuperação. Resultados: A via aérea foi assegurada com TET em 41 pacientes e ML em 39 pacientes. A segurança das vias aéreas foi estabelecida em todos os pacientes sem intercorrências durante todo o procedimento. Os níveis médios de pressão arterial e frequência cardíaca aumentaram para >20% dos níveis basais nos períodos de intubação e extubação em mais pacientes no grupo TET do que no grupo ML (27 vs. 3; p = 0,07 e 11 vs. 2; p = 0,021). Eventos adversos respiratórios, incluindo esforço e tosse, foram observados em dez pacientes no grupo TET, mas apenas em um paciente no grupo ML (p = 0,013). Os tempos para extubação, avaliação neurológica e alta da unidade de angiografia foram semelhantes (p > 0,05). Conclusão: Concluiu-se que a ML proporcionou segurança das vias aéreas suficiente como o TET e pode ser usada como alternativa ao TET para TEVs sob anestesia geral.
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References
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Submitted date:
08/04/2019
Accepted date:
12/11/2021
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