Background:
The incidence of adverse events and desaturation during airway-securing procedures (a sequence from preoxygenation to completion of tracheal intubation or supraglottic airway placement) under general anesthesia in children remains underexplored. Thus, we investigated the incidence of adverse and desaturation events and associated risk factors.
Methods:
This was a prospective, multicenter, observational study conducted between June 2022 and January 2024 in 10 tertiary care (six pediatric and four university [mixed adult-pediatric]) hospitals in Japan. A standardized data collection system was applied through the recruited institutions to collect ≥95% of cases. The primary and secondary outcomes were adverse events and a ≥10% drop in oxygen saturation (desaturation) associated with airway-securing procedures.
Results:
There were 17007 airway management procedures in 16695 children (mean age 6.3 years, standard deviation 4.8). Any adverse events occurred in 346/17007 (2.0%; 95% CI, 1.8–2.3) children, including 189/17007 (1.1%; 0.96–1.3) respiratory adverse events. Desaturation occurred during 395/17007 (2.3%; 2.1–2.6) procedures, with 66/308 (21.4%; 17.0–26.4) in neonates and 210/2298 (9.1%; 8.0–10.4) in infants. Multilevel regression analysis showed younger age (adjusted odds ratio 0.92, 95% CI, 0.90–0.95; p<0.001), airway management in radiation diagnostic/therapy rooms (5.7, 1.64–19.9; p=0.006), airway sensitivity (1.46, 1.09–1.94; P=0.010), craniocervical surgery (1.41, 1.09–1.83; p=0.009), and presence of 1 or ≥2 anatomical difficult airway features (1.74, 1.02–2.95; p=0.042 and 2.82, 1.21–6.6; p=0.017, respectively) as risk factors of any adverse events. Supraglottic airway device usage at the first attempt and muscle relaxant administration (0.42, 0.288–0.62; p<0.001 and 0.62, 0.43–0.89; p=0.009, respectively) showed a beneficial effect.
Conclusions:
The J-PEDIA study demonstrated adverse event and desaturation incidences and the impact of clinically relevant risk factors during airway-securing procedures in Asian children. This study can help anesthesiologists to identify high-risk children and create a safe airway-securing strategy.