Cargando…

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children

BACKGROUND: The variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tert...

Descripción completa

Detalles Bibliográficos
Autores principales: Oofuvong, Maliwan, Geater, Alan Frederick, Chongsuvivatwong, Virasakdi, Pattaravit, Ngamjit, Nuanjun, Kanjana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016417/
https://www.ncbi.nlm.nih.gov/pubmed/24597484
http://dx.doi.org/10.1186/1471-2253-14-13
_version_ 1782315498684284928
author Oofuvong, Maliwan
Geater, Alan Frederick
Chongsuvivatwong, Virasakdi
Pattaravit, Ngamjit
Nuanjun, Kanjana
author_facet Oofuvong, Maliwan
Geater, Alan Frederick
Chongsuvivatwong, Virasakdi
Pattaravit, Ngamjit
Nuanjun, Kanjana
author_sort Oofuvong, Maliwan
collection PubMed
description BACKGROUND: The variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tertiary care hospital in southern Thailand. METHODS: The surveillance anesthetic database and chart review of IRE of 14,153 children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 were used to obtain demographic, surgical and anesthesia-related data. Incidence density of IRE per person-time was determined by a Poisson modelling. Risk of IRE over time was displayed using Kaplan Meier survival and Nelson-Aalen curves. Multivariate Cox regression was employed to identify independent predictors for IRE. Adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were obtained from the final Cox model. RESULTS: Overall, IRE occurred in 315 out of 14,153 children. The number (%) of desaturation, wheezing or bronchospasm, laryngospasm, reintubation and upper airway obstruction were 235 (54%), 101 (23%), 75 (17%), 21 (5%) and 4 (1%) out of 315 IRE, respectively. The incidence density per 100,000 person-minutes of IRE at the induction period (61.3) was higher than that in the maintenance (13.7) and emergence periods (16.5) (p < 0.001). The risk of desaturation, wheezing and laryngospasm was highest during the first 15, 20 and 30 minutes of anesthesia, respectively. After adjusting for age, history of respiratory disease and American Society of Anesthesiologist (ASA) classification, anesthesia-related risk factors for laryngospasm were assisted ventilation via facemask (HR: 18.1, 95% CI: 6.4-51.4) or laryngeal mask airway (HR: 12.5, 95% CI: 4.6-33.9) compared to controlled ventilation via endotracheal tube (p < 0.001), and desflurane (HR: 11.0, 95% CI: 5.1-23.9) compared to sevoflurane anesthesia (p < 0.001). CONCLUSIONS: IRE risk was highest in the induction and early maintenance period. Assisted ventilation via facemask or LMA and desflurane anesthesia were anesthesia-related risk factors for laryngospasm. Therefore, anesthesiologists should pay more attention during the induction and early maintenance period especially when certain airway devices incorporated with assisted ventilation or desflurane are used.
format Online
Article
Text
id pubmed-4016417
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-40164172014-05-11 Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children Oofuvong, Maliwan Geater, Alan Frederick Chongsuvivatwong, Virasakdi Pattaravit, Ngamjit Nuanjun, Kanjana BMC Anesthesiol Research Article BACKGROUND: The variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tertiary care hospital in southern Thailand. METHODS: The surveillance anesthetic database and chart review of IRE of 14,153 children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 were used to obtain demographic, surgical and anesthesia-related data. Incidence density of IRE per person-time was determined by a Poisson modelling. Risk of IRE over time was displayed using Kaplan Meier survival and Nelson-Aalen curves. Multivariate Cox regression was employed to identify independent predictors for IRE. Adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were obtained from the final Cox model. RESULTS: Overall, IRE occurred in 315 out of 14,153 children. The number (%) of desaturation, wheezing or bronchospasm, laryngospasm, reintubation and upper airway obstruction were 235 (54%), 101 (23%), 75 (17%), 21 (5%) and 4 (1%) out of 315 IRE, respectively. The incidence density per 100,000 person-minutes of IRE at the induction period (61.3) was higher than that in the maintenance (13.7) and emergence periods (16.5) (p < 0.001). The risk of desaturation, wheezing and laryngospasm was highest during the first 15, 20 and 30 minutes of anesthesia, respectively. After adjusting for age, history of respiratory disease and American Society of Anesthesiologist (ASA) classification, anesthesia-related risk factors for laryngospasm were assisted ventilation via facemask (HR: 18.1, 95% CI: 6.4-51.4) or laryngeal mask airway (HR: 12.5, 95% CI: 4.6-33.9) compared to controlled ventilation via endotracheal tube (p < 0.001), and desflurane (HR: 11.0, 95% CI: 5.1-23.9) compared to sevoflurane anesthesia (p < 0.001). CONCLUSIONS: IRE risk was highest in the induction and early maintenance period. Assisted ventilation via facemask or LMA and desflurane anesthesia were anesthesia-related risk factors for laryngospasm. Therefore, anesthesiologists should pay more attention during the induction and early maintenance period especially when certain airway devices incorporated with assisted ventilation or desflurane are used. BioMed Central 2014-03-05 /pmc/articles/PMC4016417/ /pubmed/24597484 http://dx.doi.org/10.1186/1471-2253-14-13 Text en Copyright © 2014 Oofuvong et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Oofuvong, Maliwan
Geater, Alan Frederick
Chongsuvivatwong, Virasakdi
Pattaravit, Ngamjit
Nuanjun, Kanjana
Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title_full Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title_fullStr Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title_full_unstemmed Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title_short Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
title_sort risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016417/
https://www.ncbi.nlm.nih.gov/pubmed/24597484
http://dx.doi.org/10.1186/1471-2253-14-13
work_keys_str_mv AT oofuvongmaliwan riskovertimeandriskfactorsofintraoperativerespiratoryeventsahistoricalcohortstudyof14153children
AT geateralanfrederick riskovertimeandriskfactorsofintraoperativerespiratoryeventsahistoricalcohortstudyof14153children
AT chongsuvivatwongvirasakdi riskovertimeandriskfactorsofintraoperativerespiratoryeventsahistoricalcohortstudyof14153children
AT pattaravitngamjit riskovertimeandriskfactorsofintraoperativerespiratoryeventsahistoricalcohortstudyof14153children
AT nuanjunkanjana riskovertimeandriskfactorsofintraoperativerespiratoryeventsahistoricalcohortstudyof14153children