• Nicola Disma, Katalin Virag, Thomas Riva, Jost Kaufmann, Thomas Engelhardt, Walid Habre, NECTARINE Group of the European Society of Anaesthesiology Clinical Trial Network, AUSTRIA (Maria Vittinghoff), BELGIUM (Francis Veyckemans), CROATIA (Sandra Kralik), CZECH REPUBLIC (Jiří Žurek), DENMARK (Tom Hansen), ESTONIA (Reet Kikas), FINLAND (Tuula Manner), FRANCE (Christophe Dadure, Anne Lafargue), GERMANY (Karin Becke, Claudia Hoehne), GREECE (Anna Malisiova), HUNGARY (Andrea Székely), IRELAND (Brendan O’Hare), ITALY (Nicola Disma), LATVIA (Zane Straume), LITHUANIA (Laura Lukosiene), LUXEMBOURG (Bernd Schmitz), MALTA (Francis Borg), NETHERLANDS (Jurgen de Graaff), NORWAY (Wenche B Boerke), POLAND (Marzena Zielinska), PORTUGAL (Maria Domingas Patuleia), ROMANIA (Radu Tabacaru), SERBIA (Dusica Simic), SLOVAKIA (Miloslav Hanula), SLOVENIA (Jelena Berger), SPAIN (Ignacio Gálvez Escalera), SWEDEN (Albert Castellheim), SWITZERLAND (Walid Habre), TURKEY (Dilek Özcengiz - Zehra Hatipoğlu), UKRAINE (Dmytro Dmytriiev), UNITED KINGDOM (Thomas Engelhardt, Suellen Walker), and Management Team.
• Unit for Research & Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy. Electronic address: nicoladisma@icloud.com.
• Br J Anaesth. 2021 Jun 1; 126 (6): 1173-1181.

BackgroundNeonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.MethodsWe performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.ResultsTracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.ConclusionsThe results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.Clinical Trial RegistrationNCT02350348.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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