BACKGROUND Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia. METHODS This study used data from an international observational registry, the Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways. The use of sedation versus general anesthesia for tracheal intubation were compared. The primary outcome was the first-attempt success of tracheal intubation. Secondary outcomes included the number of intubation attempts and nonsevere and severe complications. Propensity score matching was used with a matching ratio up to 1:15 to reduce bias due to measured confounders. RESULTS Between 2017 and 2020, 34 hospitals submitted 1,839 anticipated difficult airway cases that met inclusion criteria for the study. Of these, 75 patients received sedation, and 1,764 patients received general anesthesia. Propensity score matching resulted in 58 patients in the sedation group and 522 patients in the general anesthesia group. The rate of first-attempt success of tracheal intubation was 28 of 58 (48.3%) in the sedation group and 250 of 522 (47.9%) in the general anesthesia group (odds ratio, 1.06; 95% CI, 0.60 to 1.87; P = 0.846). The median number of intubations attempts was 2 (interquartile range, 1 to 3) in the sedation group and 2 (interquartile range, 1, 2) in the general anesthesia group. The general anesthesia group had 6 of 522 (1.1%) intubation failures versus 0 of 58 in the sedation group. However, 16 of 58 (27.6%) sedation cases had to be converted to general anesthesia for successful tracheal intubation. Complications were similar between the groups, and the rate of severe complications was low. CONCLUSIONS Sedation and general anesthesia had a similar rate of first-attempt success of tracheal intubation in children with difficult airways; however, 27.6% of the sedation cases needed to be converted to general anesthesia to complete tracheal intubation. Complications overall were similar between the groups, and the rate of severe complications was low. EDITOR’S PERSPECTIVE

中文翻译：

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困难气道儿童气管插管的镇静与全身麻醉：来自儿科困难插管登记处的队列研究。

背景 镇静和清醒气管插管方法被认为对气道困难的成人最安全，但对儿童镇静插管的结果知之甚少。本研究的主要目的是比较镇静气管插管与全身麻醉下气管插管的首次气管插管成功率。假设是与全身麻醉相比，镇静插管的首次尝试成功率较低且并发症较多。方法 本研究使用的数据来自国际观察性登记处，即儿科困难插管登记处，该登记处前瞻性地收集有关气道困难儿童气管插管的数据。比较了镇静剂与全身麻醉在气管插管中的应用。主要结果是气管插管的首次尝试成功。次要结果包括插管尝试次数以及非严重和严重并发症。使用倾向得分匹配，匹配比率高达 1:15，以减少由于测量的混杂因素引起的偏差。结果 2017 年至 2020 年间，34 家医院提交了 1,839 例符合研究纳入标准的预期困难气道病例。其中，75 名患者接受了镇静，1,764 名患者接受了全身麻醉。倾向评分匹配得出镇静组 58 例患者和全身麻醉组 522 例患者。镇静组 58 例中的 28 例 (48.3%) 和全麻组 522 例中的 250 例 (47.9%) 首次气管插管成功率（比值比，1.06；95% CI，0.60 至 1.87；P = 0.846）。镇静组插管尝试的中位数为 2 次（四分位距，1 至 3 次），全身麻醉组为 2 次（四分位距，1、2 次）。全身麻醉组 522 例中有 6 例 (1.1%) 插管失败，而镇静组 58 例中有 0 例插管失败。然而，58 例镇静病例中有 16 例 (27.6%) 必须转为全身麻醉才能成功气管插管。两组之间的并发症相似，严重并发症的发生率很低。结论镇静与全身麻醉对困难气道患儿气管插管的首次成功率相似；然而，27.6%的镇静病例需要转为全身麻醉才能完成气管插管。两组之间的总体并发症相似，严重并发症的发生率很低。