Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHI Xiuyi ¹ ,  LIU Lunxu ² , Writing Committee of Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2020 edition)

1. Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, P.R.China;
2. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZHI Xiuyi, Email: xiuyizhi2015@163.com; LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Airway management; thoracic surgery; perioperative period; clinical guideline; recommendations

DOI：

10.7507/1007-4848.202012090

Video：

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Objective The clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals.Methods A total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended.Results Smoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough.Conclusion For perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.

Citation： ZHI Xiuyi, LIU Lunxu, Writing Committee of Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2020 edition). Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 251-262. doi: 10.7507/1007-4848.202012090 Copy

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