Awake Versus Asleep Intubation for Mediastinal Goiters: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
ImportanceMediastinal goiters can complicate anesthetic management, and although awake bronchoscopic intubation is the gold standard, it is resource-intensive and may be unpleasant for patients. In many centers across North America, patients undergoing thyroidectomy for mediastinal goiters are routinely intubated awake.ObjectiveThis study aimed to evaluate the outcomes of intubation in patients selected for awake versus asleep intubation for thyroidectomy of mediastinal goiters.DesignPRISMA 2020 Checklist for systematic reviews was followed. A search was performed in the Medline, Embase, Web of Science, CINAHL, Scopus, and Cochrane databases. Two independent reviewers performed abstract and full-text review. Data were extracted in duplicate. Study quality was assessed using the JBI Critical Appraisal tool. To account for heterogeneity, a 3-level random-effects model was constructed using the Der Simonian and Laird method with an arcsine transformation.Setting and ParticipantsPatients undergoing thyroidectomy for benign mediastinal goiters.Intervention and ExposuresAwake or asleep intubation.Main Outcome(s) and Measure(s)Rate of failed intubations in asleep intubation and proportion of uncomplicated intubations in asleep and awake populations.ResultsTwelve of 490 identified studies, involving 1002 patients, were included. Three cases of failed intubations were found in the asleep intubation group, with an overall incidence of failed intubation of 0.3%. Meta-analysis demonstrated an overall uncomplicated intubation rate of 91% (95% CI 77%-98%, n = 1002). Subgroup analyses showed a 96% success rate (95% CI 73%-100%, n = 60) for awake intubations and 88% (95% CI 69%-98%, n = 942) for asleep intubations. Further refined analyses showed uncomplicated intubation rates of 98% (95% CI 93%-100%, n = 469) for asleep, and 92% (95% CI 78%-99%, n = 48) for awake groups.Conclusions and RelevanceThe risk of failed intubation in patients with mediastinal goiters remains low, and awake intubation may require more attempts than asleep intubation. Further research with standardized definitions of intubation difficulty is needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.040 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".