Background
Methods
Participants
Anesthesia practice
Standard operating procedures
Outcome of interest and variables
Definitions of periods of anesthesia
Statistical analysis
Sample size considerations
Results
Period of anesthesia (person-minutes) | Induction (200,584) | Maintenance (1,156,812) | Emergence (206,453) | p-value |
---|---|---|---|---|
IRE | Number (incidence per 100,000 person-minutes) | |||
Desaturation | 90 (44.9) | 124 (10.7) | 21 (10.2) | < 0.001 |
Wheezing | 48 (23.9) | 41 (3.5) | 12 (5.8) | < 0.001 |
Laryngospasm | 27 (13.5) | 38 (3.3) | 10 (4.8) | < 0.001 |
UAO & reintubation | 1 (0.5) | 15 (1.3) | 7 (3.4) | 0.056 |
Any | 123 (61.3) | 158 (13.7) | 34 (16.5) | < 0.001 |
Characteristic profiles of intraoperative desaturation, wheezing, laryngospasm and UAO in combination with reintubation
Univariate and Cox regression analysis of IRE
Variable | All periods (315) | Induction (123) | Maintenance (158) | Emergence (34) |
---|---|---|---|---|
Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | |
Age (ref= > 6) | _ | 1a 0.004 | 1a < 0.001 | 1a 0.048 |
1-6 | 1.5 (0.94, 2.3)a
| 2.3 (1.6, 3.4)b
| 2.0 (1.0, 4.1)a
| |
< 1 | 2.5 (1.5, 4.2)b
| 3.0 (1.8, 4.8)b
| 3.1 (1.2, 8.2)b
| |
Respiratory disease (ref = no) | _ | 1a < 0.001 | 1a 0.008 | 1a 0.2 |
URI | 1.4 (0.67, 2.9)a
| 2.2 (1.3, 3.7)b
| 2.1 (0.72, 6.3)a
| |
Pulmonary disease | 3.5 (2.3, 5.5)b
| 1.6 (0.9, 2.8)a
| 2.1 (0.81, 5.7)a
| |
Site of operation (ref = superficial) | 1a < 0.001 | _ | _ | _ |
Broncho/laryngoscopy | 3.6 (2.0, 6.6)b
| |||
Ear-nose-throat | 1.6 (0.86, 2.8)a
| |||
Eye | 1.0 (0.55, 1.8)a
| |||
Thoracic | 1.1 (0.59, 2.2)a
| |||
Abdomen | 1.4 (0.83, 2.4)a
| |||
Spine & extremity | 1.3 (0.74, 2.3)a
| |||
Remote* | 1.3 (0.48, 2.8)a
| |||
Position (ref = supine) | 1a 0.009 | _ | _ | _ |
Lateral | 2.0 (1.3, 3.1)b
| |||
Lithotomy | 0.50 (0.23, 1.1)a
| |||
Prone | 1.1 (0.51, 2.2)a b
| |||
ASA classification (ref = 1) | 1a < 0.001 | 1a 0.83 | 1a 0.75 | |
2 | _ | 1.7 (0.96, 3.1)a
| 1.0 (0.66,1.5)a
| 1.3 (0.64, 2.7)a
|
3 | 4.0 (2.1, 7.8)b
| 1.1 (0.66, 2.0)a
| 1.2 (0.38, 3.8)a
| |
Airway device (ref = ETT-C) | 1a < 0.001 | |||
Jet ventilation-C | 2.4 (1.1, 5.1)b
| _ | _ | _ |
Facemask-A | 2.4 (1.4, 4.0)b
| |||
LMA-A | 2.0 (1.2, 3.3)b
| |||
Intubating agent (ref = NDMR) | 1a < 0.001 | |||
Succinylcholine | 1.7 (1.2, 2.2)b
| _ | _ | _ |
Sevoflurane | 1.6 (0.9, 2.7)ab
| |||
Inhalation agent (ref = sevoflurane) | 1a 0.0013 | |||
Isoflurane | 0.77 (0.58, 1.0)a
| |||
Halothane | 0.82 (0.26, 2.6)a
| _ | _ | _ |
Desflurane | 3.9 (2.1, 7.2)b
|
Variable | All periods (235) | Induction (90) | Maintenance (124) | Emergence (21) |
---|---|---|---|---|
Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | |
Age (ref= > 6) | 1a < 0.001 | |||
1-6 | 2.3 (1.6, 3.3)b
| _ | _ | _ |
< 1 | 3.7 (2.5, 5.6)c
| |||
Respiratory disease (ref = no) | 1a < 0.001 | 1a 0.16 | 1a 0.6 | |
URI | _ | 1.1 (0.45, 2.9)a
| 1.7 (0.89, 3.2)a
| 1.5 (0.34, 6.8)a
|
Pulmonary disease | 3.9 (2.4, 6.3)b
| 1.6 (0.84, 2.9)a
| 1.9 (0.54, 6.5)a
| |
Site of operation (ref = superficial) | 1a < 0.001 | |||
Broncho/laryngoscopy | 4.1 (2.1, 8.3)b
| |||
Ear-nose-throat | 1.7 (0.87, 3.4)a
| |||
Eye | 1.0 (0.49, 2.1)a
| _ | _ | _ |
Thoracic | 1.3 (0.62, 2.8)a
| |||
Abdomen | 1.3 (0.70, 2.4)a
| |||
Spine & extremity | 1.2 (0.63, 2.4)a
| |||
Remote* | 1.7 (0.64, 4.3)a
| |||
Position (ref = supine) | 1a 0.01 | |||
Lateral | 2.0 (1.2, 3.3)b
| _ | _ | _ |
Lithotomy | 0.42 (0.15, 1.2)a
| |||
Prone | 0.77 (0.28, 2.1)a
| |||
ASA classification (ref = 1) | 1a < 0.001 | 1a 0.75 | 1a 0.93 | |
2 | _ | 1.9 (0.92, 3.9)a
| 1.1 (0.66,1.7)a
| 1.1 (0.56, 2.2)a
|
3 | 4.4 (2.0, 9.6)b
| 1.3 (0.70, 2.3)a
| 0.90 (0.25, 3.1)a
| |
Airway device (ref = ETT-C) | 1a 0.005 | |||
Jet ventilation-C | 2.2 (0.89, 5.3)a
| _ | _ | _ |
Facemask-A | 2.5 (1.3, 4.7)b
| |||
LMA-A | 2.0 (1.1, 3.6)b
| |||
Intubating agent (ref = NDMR) | 1a < 0.001 | |||
Succinylcholine | 2.0 (1.4, 2.8)b
| _ | _ | _ |
Sevoflurane | 1.2 (0.62, 2.4)a
| |||
Inhalation agent (ref = sevoflurane) | 1a < 0.001 | |||
Isoflurane | 0.79 (0.57, 1.1)a
| |||
Halothane | 1.2 (0.40, 3.8)a
| _ | _ | _ |
Desflurane | 5.7 (3.1, 10.7)b
|
Variable | All periods (101) | Induction (48) | Maintenance (41) | Emergence (12) |
---|---|---|---|---|
Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | |
Respiratory disease (ref = no) | 1a < 0.001 | |||
URI | 3.5 (2.0, 6.2)b
| _ | _ | _ |
Pulmonary disease | 2.9 (1.7, 5.1)b
| |||
ASA classification (ref = 1) | 1a 0.014 | _ | _ | _ |
2 | 2.0 (0.99, 3.9)a
| |||
3 | 2.9 (1.4, 6.1)b
|
Variable | All periods (75) | Induction (27) | Maintenance (38) | Emergence (10) |
---|---|---|---|---|
Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | |
Age (ref= > 6) | 1a 0.08 | 1a 0.004 | 1a 0.002 | |
1-6 | _ | 1.4 (0.57, 3.6)a
| 3.4 (1.5, 7.8)b
| 8.5 (1.8, 40.3)b
|
< 1 | 3.7 (1.2, 11.3)b
| 3.4 (0.99, 11.6)a
| 27.4 (5.2, 143.2)c
| |
Respiratory disease (ref = no) | 1a 0.02 | s | ||
URI | 1.7 (0.78, 3.7)a
| _ | _ | _ |
Pulmonary disease | 3.1 (1.5, 6.4)b
| |||
ASA classification (ref = 1) | 1a 0.23 | |||
2 | 0.82 (0.47, 1.4)a
| _ | _ | _ |
3 | 0.39 (0.12, 1.3)a
| |||
Airway device (ref = ETT-C) | 1a < 0.001 | |||
Jet ventilation-C | _ | |||
Facemask-A | 18.1 (6.4, 51.4)b
| |||
LMA-A | 12.5 (4.6, 33.9)b
| |||
Intubating agent (ref = NDMR) | 1a < 0.001 | 1a 0.67 | ||
Succinylcholine | _ | 13.5 (3.9, 46.3)b
| 1.4 (0.28, 6.9)a
| _ |
Sevoflurane | 1.9 (0.18, 19.5)a
| 2.8 (0.6, 13.0)a
| ||
Inhalation agent (ref = sevoflurane) | 1a < 0.001 | |||
Isoflurane | 0.75 (0.38, 1.5)a
| _ | _ | _ |
Halothane | 1.6 (0.37, 6.5)a
| |||
Desflurane | 11.0 (5.1, 23.9)b
|
Variable | All periods (23) | Induction (1) | Maintenance (15) | Emergence (7) |
---|---|---|---|---|
Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | Adjusted hazard ratio (95% CI) p-value | |
Age (ref= > 6) | 1a 0.01 | 1a 0.005 | ||
1-6 | _ | _ | 3.7 (0.90, 14.6)a
| 4.7 (0.90, 23.3)a
|
< 1 | 9.2 (2.2, 39.0)b
| 18.5 (3.7, 93.6)b
| ||
Site of operation (ref = superficial) | 1a < 0.001 | |||
Broncho/laryngoscopy | 22.8 (2.6, 201.8)b
| |||
Ear-nose-throat | 4.7 (0.57, 38.3)a
| _ | _ | _ |
Eye | _ | |||
Thoracic | 0.83 (0.05, 13.3)a
| |||
Abdomen | 1.2 (0.13, 9.9)a
| |||
Spine & extremity | 1.4 (0.14, 13.7)a
| |||
Remote* | _ |