scholarly journals Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia

2020 ◽  
Author(s):  
Jia-Yi Wang ◽  
Jing-Jie Li ◽  
Peng-Cheng Zhao ◽  
Jia-Li Peng ◽  
Rong Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Elective Surgery ◽  
Chinese Patients ◽  
Apnea Hypopnea Index ◽  
Mask Ventilation ◽  
Clinical Trial Registry ◽  
Difficult Mask Ventilation ◽  
Physical Status Classification ◽  
Obstructive Sleep

Abstract Background: Difficult Mask Ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. Accordingly, the majority of current airway management guidelines include risk assessments for DMV. Although Obstructive Sleep Apnea (OSA) is among the most important risk factors associated with DMV, other measurements such as the Apnea-Hypopnea Index (AHI) may play an important role in determining patient risk.This study investigated the relationship between DMV and AHI, and determined preoperative risk factors for DMV in Chinese patients.Methods: A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. Inclusion criteria: Patients >18 years of age, American Society of Anesthesiologists Physical Status Classification (ASA) I-III, and planned elective surgery with general anesthesia. Exclusion criteria: malformations of the airway, patients undergoing regional anesthesia, and patients with contraindications to mask ventilation (i.e. planned awake intubation). A logistic regression model was used to analyze the association between AHI and DMV. Results: A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases of 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV.Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy DMV screening.Trial registration: Chinese Clinical Trial Registry (Registration number # ChiCTR17013076; Date of Registration on October 22nd, 2017).

scholarly journals Utilization of apnea-hypopnea index as a novel predictive factor for difficult mask ventilation in the Chinese population under general anesthesia

2021 ◽  
Author(s):  
Jiayi Wang ◽  
Jingjie Li ◽  
Pengcheng Zhao ◽  
Xuan Pu ◽  
Rong Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elective Surgery ◽  
Chinese Patients ◽  
Apnea Hypopnea Index ◽  
Mask Ventilation ◽  
Clinical Predictors ◽  
Clinical Trial Registry ◽  
Difficult Mask Ventilation ◽  
Obstructive Sleep ◽  
Threatening Situation

Abstract Purpose Difficult mask ventilation (DMV) is a potentially life-threatening situation that can arise during anesthesia. However, most clinical predictors of DMV are based on European and US populations. On the other hand, most predictive models consist of multiple factors and complicated assessments. Since obstructive sleep apnea (OSA) is among the most important risk factors associated with DMV, the apnea-hypopnea index (AHI) may play an important role in determining patient risk.The purpose of this study was to investigate the relationship between DMV and AHI, and to determine preoperative risk factors for DMV in Chinese patients. Methods A prospective cohort trial enrolled patients scheduled for elective surgery. After obtaining informed consent, patient demographic information was collected, and patients were tested with pre-operative polysomnography. The anesthesiologist who managed the airway graded the mask ventilation. The difficult mask ventilation was defined as the mask ventilation provided by an unassisted anesthesiologist without oral airway or other adjuvant. A logistic regression model was used to analyze the association between AHI and DMV. Results A total of 159 patients were analyzed. For both primary and secondary outcomes, the unadjusted and adjusted odds ratio for DMV showed significant increases by 5 AHI units. AHI, age, and the Mallampati classification were found to be independent predictive factors for DMV. Conclusions AHI is associated with DMV as a novel independent risk factor in Chinese patients. Along with age and Mallampati classification, AHI should be included in establishing a superior predictive strategy for DMV screening. Trial registration Chinese Clinical Trial Registry ChiCTR-DDD-17013076

scholarly journals Difficult mask ventilation in general surgical population: observation of risk factors and predictors

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 204 ◽  
Author(s):  
Davide Cattano ◽  
Peter V. Killoran ◽  
Chunyan Cai ◽  
Anastasia D. Katsiampoura ◽  
Ruggero M. Corso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elective Surgery ◽  
Univariate Analysis ◽  
Predictive Score ◽  
Mask Ventilation ◽  
Individual Subject ◽  
Facial Hair ◽  
Difficult Mask Ventilation ◽  
Obstructive Sleep ◽  
Patients At Risk

Background: There are few predictors of difficult mask ventilation and a simple, objective, predictive system to identify patients at risk of difficult mask ventilation does not currently exist. We present a retrospective - subgroup analysis aimed at identifying predictive factors for difficult mask ventilation (DMV) in patients undergoing pre-operative airway assessment before elective surgery at a major teaching hospital.Methods: Data for this retrospective analysis were derived from a database of airway assessments, management plans, and outcomes that were collected prospectively from August 2008 to May 2010 at a Level 1 academic trauma center. Patients were stratified into two groups based on the difficulty of mask ventilation and the cohorts were analyzed using univariate analysis and stepwise selection method.Results: A total of 1399 pre-operative assessments were completed with documentation stating that mask ventilation was attempted. Of those 1399, 124 (8.9%) patients were found to be difficult to mask ventilate. A comparison of patients with and without difficult mask ventilation identified seven risk factors for DMV: age, body mass index (BMI), neck circumference, history of difficult intubation, presence of facial hair, perceived short neck and obstructive sleep apnea. Although seven risk factors were identified, no individual subject had more than four risk factors.Conclusion: The results of this study confirm that in a real world clinical setting, the incidence of DMV is not negligible and suggest the use of a simple bedside predictive score to improve the accuracy of DMV prediction, thereby improving patient safety. Further prospective studies to validate this score would be useful.

scholarly journals Upside-Down Mask Ventilation Technique for a Patient With a Long and Narrow Mandible

2014 ◽  
Vol 61 (4) ◽  
pp. 169-170
Author(s):  
Takuro Sanuki ◽  
Toshihiro Watanabe ◽  
Yu Ozaki ◽  
Mizuki Tachi ◽  
Kensuke Kiriishi ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Basic Skills ◽  
Mask Ventilation ◽  
Common Cause ◽  
Facial Anomalies ◽  
Difficult Mask Ventilation ◽  
Gas Leak ◽  
Ventilation Technique

Abstract Mask ventilation, along with tracheal intubation, is one of the most basic skills for managing an airway during anesthesia. Facial anomalies are a common cause of difficult mask ventilation, although numerous other factors have been reported. The long and narrow mandible is a commonly encountered mandibular anomaly. In patients with a long and narrow mandible, the gaps between the corners of the mouth and the lower corners of the mask are likely to prevent an adequate seal and a gas leak may occur. When we administer general anesthesia for these patients, we sometimes try to seal the airway using several sizes and shapes of commercially available face masks. We have found that the management of the airway for patients with certain facial anomalies may be accomplished by attaching a mask upside down.

scholarly journals Role of β-type natriuretic peptide as predictor of early post-operative outcomes in Chinese patients undergoing anesthesia

2017 ◽  
Vol 12 (4) ◽  
pp. 393
Author(s):  
Chun Chen ◽  
Lei Lin
Keyword(s):  
Hospital Stay ◽  
General Anesthesia ◽  
Natriuretic Peptide ◽  
Elective Surgery ◽  
Chinese Patients ◽  
Operative Outcomes ◽  
Study Results ◽  
Before And After ◽  
Prolonged Hospital ◽  
Relationship Of

<p class="Abstract">The purpose of the present study was to assess whether pre-operative and post-operative B-type natriuretic peptide (BNP) levels could be used as the predictor of post-operative complications in Chinese patients undergoing elective surgery under general anesthesia. A total of 80 adult patients were analyzed. Blood sample to measure BNP was collected from each patient before and after surgery to assess the relationship of pre-operative BNP with all possible clinical outcomes. Elevated BNP levels were associated with prolonged hospital stay and mortality. Our study results suggested that the high levels of BNP predict the prolong hospital stay, increased mortality, and increased usage of balloon pump. Also results suggested that the BNP is one of the key predictors of early post-operative outcomes in Chinese patients undergoing elective surgery under general anesthesia.</p>

Obstructive sleep apnea and the progression of thoracic aortic aneurysm: a prospective cohort study

2020 ◽  
pp. 2003322
Author(s):  
Thomas Gaisl ◽  
Protazy Rejmer ◽  
Maurice Roeder ◽  
Patrick Baumgartner ◽  
Noriane A. Sievi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Elective Surgery ◽  
Positive Association ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Apnea Hypopnea Index ◽  
Aortic Sinus ◽  
Obstructive Sleep

BackgroundObstructive sleep apnea (OSA) is associated with an increased prevalence of aortic aneurysms, and it has also been suggested that severe OSA furthers aneurysm expansion in the abdomen. We evaluated whether OSA is a risk factor for the progression of ascending thoracic aortic aneurysms (TAA).MethodsPatients with TAA underwent yearly standardised echocardiographic measurements of the ascending aorta over 3 years, and two level-III sleep studies. The primary outcome was the expansion rate of TAA in relation to the apnea-hypopnea-index (AHI). Secondary outcomes included surveillance for aortic events (composite endpoints of rupture, dissection, elective surgery, and death).ResultsBetween July 2014 and March 2020, 230 patients (median age 70 years, 78% male) participated in the cohort. At baseline, 34.8% of patients had an AHI of ≥15 events·h−1. There was no association between TAA diameters and the AHI at baseline. After 3 years mean expansion rates were 0.55±1.25 mm at the aortic sinus and 0.60±1.12 mm at the ascending aorta. In the regression analysis, after controlling for baseline diameter and cardiovascular risk factors, there was strong evidence for a positive association of TAA expansion with AHI (aortic sinus estimate 0.025 mm [95%CI 0.009 to 0.040], p<0.001; ascending aorta estimate 0.026 mm [95%CI 0.011 to 0.041], p=0.001). Twenty participants (8%) experienced an aortic event, however, there was no association with OSA severity.ConclusionOSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.

scholarly journals Obstructive Sleep Apnea as a Predictor of Abnormal Heart Rate Turbulence

2019 ◽  
Vol 9 (1) ◽  
pp. 1 ◽  
Author(s):  
Dominika Urbanik ◽  
Paweł Gać ◽  
Helena Martynowicz ◽  
Małgorzata Poręba ◽  
Maciej Podgórski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Holter Monitoring ◽  
Older Age ◽  
Apnea Hypopnea Index ◽  
Heart Rate Turbulence ◽  
Obstructive Sleep ◽  
Independent Risk Factors

Obstructive sleep apnea (OSA) causes dysfunction of the autonomic nervous system, but the exact mechanism has not been fully understood. The aim of this study was to analyse the relationship between the incidence and severity of OSA and heart rate turbulence (HRT). Seventy one patients with clinical suspicion of OSA were qualified to participate in the study. All participants took part in a survey and were subjected to laboratory tests, 24-hour electrocardiogram (ECG) Holter monitoring with HRT analysis and polysomnography. The group with OSA manifested significantly higher turbulence onset (TO) and lower turbulence slope (TS) as compared to the group without OSA. Older age, diabetes, hypertension and higher apnea/hypopnea index (AHI) were found to be independent risk factors for increased TO, whereas older age, higher body mass index (BMI), higher blood glucose levels, hypertension and higher AHI were independent risk factors for TS reduction. The AHI ≥65 criterion indicates abnormal HRT in patients with OSA with 94.9% sensitivity and 50.0% specificity, which gives a prediction accuracy of 85.7%. In summary, OSA should be considered as a predictor of abnormal HRT.

The incidence and risk factors of difficult mask ventilation

2005 ◽  
Vol 19 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Tulay Sahin Yildiz ◽  
Mine Solak ◽  
Kamil Toker
Keyword(s):  
Risk Factors ◽  
Mask Ventilation ◽  
Difficult Mask Ventilation
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