Best practices in peri-operative management of patients with skeletal dysplasias
Best practices in peri-operative management of patients with skeletal dysplasias
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DOI：
10.1002/ajmg.a.38357
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发表时间：
2017-10-01
影响因子：
2
通讯作者：
Theroux, Mary C.
中科院分区：
文献类型：
--
作者：
White, Klane K.;Bompadre, Viviana;Theroux, Mary C.
骨骼发育不良的患者经常需要手术。该患者人群的围手术期并发症风险增加，这些并发症与上气道解剖结构、气管-支气管形态和功能异常、胸壁畸形、上颈椎活动异常以及一般健康和体型相关问题有关。利用证据分析和专家意见，本研究旨在描述骨骼发育不良患者围手术期管理的最佳实践。一个由13名多学科国际专家组成的小组参加了一个德尔菲过程，其中包括一个彻底的文献综述; 22个可能的护理建议清单;两轮匿名投票;和一个面对面的会议。同意率超过80%的建议被认为是一致的。达成共识，以支持19个建议的最佳术前管理的骨骼发育不良患者。这些建议包括术前肺、多导睡眠图;心脏和神经系统评估;颈椎成像;以及困难气道插管和拔管患者的麻醉管理。这一基于共识的最佳实践指南的目标是提供最低限度的标准化护理，减少围手术期并发症，并改善骨骼发育不良患者的临床结局。
Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia.