Journal article
Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants A Single-center, Retrospective Study
Anesthesiology (Philadelphia), Vol.131(4), pp.830-839
01 Oct 2019
PMID: 31335549
Abstract
Background: The infant airway is particularly vulnerable to trauma from repeated laryngoscopy attempts. Complications associated with elective tracheal intubations in anesthetized infants may be underappreciated. We conducted this study of anesthetized infants to determine the incidence of multiple laryngoscopy attempts during routine tracheal intubation and assess the association of laryngoscopy attempts with hypoxemia and bradycardia.
Methods: We conducted a retrospective cross-sectional cohort study of anesthetized infants (age less than or equal to 12 months) who underwent direct laryngoscopy for oral endotracheal intubation between January 24, 2015, and August 1, 2016. We excluded patients with a history of difficult intubation and emergency procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location.
Results: A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia and bradycardia occurred in 3.7% (n = 50) of patients. Multiple laryngoscopy attempts were associated with an increased risk of hypoxemia (adjusted odds ratio: 1.78, 95% CI: 1.30 to 2.43, P < 0.001). There was no association between multiple laryngoscopy attempts and bradycardia (adjusted odds ratio: 1.23, 95% CI: 0.74 to 2.03, P = 0.255).
Conclusions: In a quaternary academic center, healthy infants undergoing routine tracheal intubations had a high incidence of multiple laryngoscopy attempts and associated hypoxemia episodes.
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Details
- Title
- Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants A Single-center, Retrospective Study
- Creators
- Jorge A. Galvez - Children's Hospital of PhiladelphiaSamuel Acquah - Raymond and Ruth Perelman School of Medicine at the University of PennsylvaniaLuis Ahumada - Children's Hospital of PhiladelphiaLingyu Cai - Drexel University, Dana and David Dornsife School of Public HealthMarcia Polanski - Drexel University, Dana and David Dornsife School of Public HealthLezhou Wu - Children's Hospital of PhiladelphiaAllan F. Simpao - Raymond and Ruth Perelman School of Medicine at the University of PennsylvaniaJonathan M. Tan - Raymond and Ruth Perelman School of Medicine at the University of PennsylvaniaJack Wasey - Children's Hospital of PhiladelphiaJohn E. Fiadjoe - Children's Hospital of Philadelphia
- Publication Details
- Anesthesiology (Philadelphia), Vol.131(4), pp.830-839
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Grant note
- Johns Hopkins School of Medicine, Baltimore, Maryland
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health
- Web of Science ID
- WOS:000489733000015
- Scopus ID
- 2-s2.0-85072747724
- Other Identifier
- 991021860800704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Anesthesiology