Perioperative Respiratory Complications Research Articles

Impact of various airway devices used in infants under general anaesthesia on perioperative respiratory complications: A prospective observational study

Impact of various airway devices used in infants under general anaesthesia on perioperative respiratory complications: A prospective observational study

Intraoperative effects of an alveolar recruitment manoeuvre in patients undergoing laparoscopic colon surgery

IntroductionPulmonary atelectasis is common in patients undergoing laparoscopic abdominal surgery under general anaesthesia, which increases the risk of perioperative respiratory complications. Alveolar recruitment manoeuvres (ARM) are used to open up the lung parenchyma with atelectasis, although the duration of their benefit has not been clearly established. The aim of this study was to determine the effectiveness of an ARM in laparoscopic colon surgery, the duration of response over time, and its haemodynamic impact. MethodsTwenty-five patients undergoing laparoscopic colon surgery were included. After anaesthetic induction and initiation of surgery with pneumoperitoneum, an ARM was performed, and then optimal PEEP determined. Respiratory mechanics and gas exchange variables, and haemodynamic parameters, were analysed before the manoeuvre and periodically over the following 90 min. ResultsThree patients were excluded for surgical reasons. The alveolar arterial oxygen gradient went from 94.3 (62.3−117.8) mmHg before to 60.7 (29.6−91.0) mmHg after the manoeuvre (P < .05). This difference was maintained during the 90 min of the study. Dynamic compliance of the respiratory system went from 31.3 ml/cmH2O (26.1–39.2) before the manoeuvre to 46.1 ml/cmH2O (37.5−53.5) after the manoeuvre (P < .05). This difference was maintained for 60 min. No significant changes were identified in any of the haemodynamic variables studied. ConclusionIn patients undergoing laparoscopic colon surgery, performing an intraoperative ARM improves the mechanics of the respiratory system and oxygenation, without associated haemodynamic compromise. The benefit of these manoeuvres lasts for at least one hour.

Elevated respiratory complications following robotic-assisted lobectomy: A national cohort analysis of 26,140 cases.

Robotic-assisted lobectomy (RL) is increasingly used nationally, but little comparative data exist on its safety compared with open lobectomy (OL) or video-assisted lobectomy (VL). This study aimed to estimate the risk of perioperative complications for RL, VL, or OL. Admissions were identified from the hospital administrative data collected between 2015 and 2019. Propensity score matching and inverse probabilistic weighting were used to account for selection bias. Logistic and quantile regression models were applied to determine perioperative outcome differences. We identified 26,140 cases of which 5337 (20.4%), 12,680 (48.5%), and 8123 (31.1%) underwent RL, VL, and OL. RL and VL were associated with lower complication rates, shorter lengths of stay, and fewer mortality risks. RL was associated with significantly elevated risks for perioperative respiratory complications (adjusted odds ratio 1.10, p=0.010). Relatively low rates of perioperative complications for VL and RL, and higher respiratory complication rates in RL are concerning.

The Effect of Parental Smoking Exposure on Perioperative Respiratory Complications in Children

The Effect of Parental Smoking Exposure on Perioperative Respiratory Complications in Children

Effect of Nebulized Salbutamol Premedication on Perioperative Respiratory Adverse Events in Children with Recent Respiratory Tract Infections

BACKGROUND&#x0D; A recent upper respiratory tract infection is linked to the development of peri-operative respiratory complications. In this study we wanted to evaluate the effect of salbutamol premedication on the incidence of peri-operative respiratory adverse events in children with a recent upper respiratory tract infection (PRAE).&#x0D; METHODS&#x0D; A randomized clinical trial study that was conducted at the Children Welfare Teaching Hospital for a period of six months. It included 90 children aged ≤ 16 years who underwent a surgical operation under general anesthesia with a laryngeal mask airway or a tracheal tube and were divided into three groups; (had a recent URTI and received preoperative salbutamol, those who had a recent URTI and didn’t receive preoperative salbutamol, and those with no URTI group). The preferred outcome was the difference in the rate of occurrence of PRAE between children who had received salbutamol and those who hadn’t.&#x0D; RESULTS&#x0D; Four children with no URTI (13.3%) developed peri-operative respiratory adverse events. The incidence of bronchospasm and severe cough was significantly higher in patients with URTI and who didn’t receive preoperative salbutamol than in those with URTI who received preoperative salbutamol.&#x0D; CONCLUSIONS&#x0D; Preoperative salbutamol doses 10 – 30 minutes before surgery have been demonstrated to reduce and treat peri-operative respiratory adverse events.

Is a Difficult Airway Team Needed for Intubation at Removal of Mandibular Distraction Devices for Infants With Robin Sequence?

Difficult airway teams (DATs) are typically present to assist intubation at the initial mandibular distraction osteogenesis (MDO) operation for infants with Robin sequence (RS). In some institutions, the RS diagnosis triggers a "difficult airway" label for the infant, requiring DAT presence for future operations. By the time of distractor removal, however, breathing and airway anatomy are significantly improved. The objective of this study was to measure intubation difficulty and perioperative respiratory complications at MDO device removal as a proxy for the necessity for coordination with a DAT. This is a retrospective study including infants with RS from 2013 to 2021 who had MDO during infancy. Patients were excluded if they had a tracheostomy or MDO device failure. Predictor variables included demographic data, comorbidities, and apnea-hypopnea indices (AHIs) from pre- and immediate post-MDO polysomnograms. The primary outcome measures were number of intubation attempts, laryngoscopy grade, and perioperative respiratory events at the distractor removal operation. Descriptive statistics were computed including Fisher's exact, paired sample t-tests, and Wilcoxon rank tests, and P<.05 was considered statistically significant. The sample included 47 (60% male) patients with a mean age at MDO of 12.0±15.7weeks. Significant improvement in AHI was seen after MDO (pre-MDO: 26.8±18.4 events/hour; post-MDO 2.78±2.66 events/hour; P<.001). Average number of intubation attempts decreased from 2.09±1.36 to 1.30±0.75 (P<.001) and the most common post-MDO laryngoscopy grade was 1 (69%). There were no intraoperative and 2 (4%) minor postoperative respiratory events, both in patients with repaired congenital cardiac disease and not related to traumatic intubation. Neither difficult intubations nor perioperative respiratory events associated with intubation trauma were seen at distractor removal, suggesting that specialty airway assistance is not routinely needed after successful MDO. DAT presence should be determined on a case-by-case basis based on specific patient risk factors.

Reliability of dynamic perfusion digital radiography as an alternative to pulmonary perfusion scintigraphy in predicting postoperative lung function and complications.

BackgroundAccurate perioperative risk assessment can enhance the perioperative management of patients undergoing radical surgery for lung cancer. In this study, we compared the accuracy of predicting perioperative complications by lung function values, estimated by blood flow ratios (BFRs), to determine whether dynamic perfusion digital radiography (DPDR) could substitute for pulmonary perfusion scintigraphy (PPS).MethodsPatients scheduled for radical surgery for lung cancer who underwent simultaneous dynamic chest radiography (DCR) and lung perfusion scintigraphy were assessed. We confirmed the agreement between two methods in the assessment of the BFR and its predicted postoperative (ppo) value. Besides, the best spirometry thresholds for the risk of perioperative respiratory or cardiovascular complications were calculated from a receiver operating characteristic (ROC) analysis. The imaging methods were compared for sensitivity and specificity.ResultsAmong the 44 cases enrolled, DPDR and PPS showed high correlations in BFR (r=0.868, P<0.01) and its postoperative value (r=0.975, P<0.01) and between the predicted and measured spirometry values. In both imaging modalities, the estimated postoperative diffusing capacity test for carbon monoxide (DLco) had the best prediction [area under the curve (AUC) >0.7] for respiratory complications within 1 month (with different cut-offs for same target cases). For predicting, respiratory complications within 1–3 months after surgery, these values were similar between two modalities. Furthermore, the ppoDLco values from both imaging methods were excellent indicators of the induction of postoperative long term oxygen therapy, with the AUC greater than 0.8.ConclusionsThis study showed that simple and less invasive DPDR can be a good alternative to PPS for predicting postoperative pulmonary function values and the risk of postoperative respiratory complications. This new imaging modality will offer new insights and possible functional analyses of pulmonary circulation.

EP13.01-010 Effect of Perioperative Respiratory Muscle Training with Gamification for Lung Cancer

It has already been reported that pre- and postoperative respiratory muscle trainings are effective in preventing perioperative respiratory complications and improving postoperative respiratory function in patients undergoing lobectomy. However, since it is a simple repetitive task, it is extremely difficult to have it continued for a long time. In this study, we developed a new respiratory training application using a tablet game and verified to what extent it is possible to continue respiratory training by applying gamification techniques.

The relationship between smoking dependence, exposure to cigarette smoke, carboxyhemoglobin and perioperative complications in patients who underwent laparoscopic cholecystectomy under general anesthesia

Objectives: The aim of this study; to determine the effects of preoperative smoking dependence and noninvasively measured carboxyhemoglobin (COHb) levels on perioperative complications in patients who underwent elective laparoscopic cholecystectomy. Methods: Ninety patients (Group I: smoker, Group II: non-smoker, and Group III: passive smoker) who underwent laparoscopic cholecystectomy under general anesthesia were studied. The level of dependence of smokers was evaluated with the Fagerstrom Test for Nicotine Dependence (FNBT). Preoperative COHb level was determined with a pulse CO-oximeter by placing a sensor on the fingertip. Respiratory complications in the perioperative and recovery room and Modified Aldrete Score (MAS) in the recovery room were recorded as 5th, 10th and 15th min. Results: Female gender was significantly higher in Groups II and III. Significant increases were noted in Group I in terms of increased perioperative secretion and incidence of bronchospasm. In the recovery room, the increase in MAS 5th min in Group I and MAS 10th min and 15th min in Group III was significantly lower. In Group I, positive correlations between the COHb level and the number of cigarettes smoked and the FNBT level, and a negative correlation between MAS and the number of hours past after the last cigarette smoked were determined. In Group II, the COHb level correlated positively with the number of cigarette smokers at home and negatively with MAS. All these correlations were statistically significant. Conclusions: It was demonstrated that cigarette smoking increased the incidence of perioperative respiratory complications under general anesthesia. Preoperative COHb level estimated by the pulse CO-oximeter can be used as an indicant of the potential risk of perioperative repiratory complications.

Incidence of perioperative respiratory complications in patients undergoing elective open upper abdominal surgery under general anaesthesia: Smokers versus non-smokers - An observational study

Background: Smoking has various deleterious effects and peri-operative complications. Pulmonary complications following abdominal surgery are frequent and associated with increased morbidity and mortality and length of hospital stay. Aims and Objectives: Hence, this study was done to observe the incidence of various respiratory and cardiovascular complications in the perioperative period in patients undergoing elective open upper abdominal surgery under general anaesthesia among smokers versus non-smokers. The various complications which are studied are as follows - Arterial desaturation, Severe coughing, Laryngospasm, Bronchospasm, Recurrent apnea, Variations in Mean Arterial Blood Pressure and Heart rates. Materials and Methods: Male patients ASA-I, II or III, aged 20–60 years undergoing elective open upper abdominal surgery under general anaesthesia were selected. They were divided into two groups (during pre-anaesthetic checkup) - smokers (&gt;10 cigarette/day for the past 1 year and continued smoking till admission), non-smokers (who never smoked). General anaesthesia was given according to standard protocol. Results: The smokers had higher incidence of laryngospasm as well as bronchospasm but they were not statistically significant. Smokers had low baseline SpO2; greater fall in SpO2 just after extubation, before sending to PACU and on day 1 which were statistically significant. Smokers had raised MAP just after extubation, on day 1 and day 2 which were statistically significant. Conclusion: Smokers had increased incidences of respiratory and hemodynamic complications than non-smokers.

Short-term Outcomes of Emergent Versus Elective Gastrectomy for Gastric Adenocarcinoma: A National Surgical Quality Improvement Program Study.

Gastric adenocarcinoma is a leading cause of cancer death worldwide and in the United States, and can present emergently with upper GI hemorrhage, obstruction, or perforation. Few large studies have examined how emergency surgery for gastric cancer affects patient outcomes. All patients from National Surgical Quality Improvement Program with gastric adenocarcinoma from 2005 to 2017 were examined retrospectively. Univariate and multivariate analysis of patient factors and perioperative outcomes was performed. P-values < .05 were significant. Of 4663 total patients, 115 had emergency surgery and 4548 had elective surgery. Emergency surgery patients were more likely to be non-white, underweight, higher ASA class, require a preoperative blood transfusion, and were less likely to be functionally independent. Multivariate analysis demonstrates an increased likelihood of unplanned intubation, prolonged ventilation, and deep vein thrombosis (DVT). There are no significant differences in mortality, reoperation, or infection when comparing emergent surgery for gastric cancer and elective surgery; however, there is an increased risk of reintubation, prolonged intubation, and DVT in patients undergoing emergent surgery. Patients requiring emergent surgery have more comorbidities, higher blood transfusion requirements, and worse preoperative functional status, and this study demonstrates that they also have worse perioperative outcomes. Previous studies have shown that long-term oncologic outcomes are worse for patients undergoing urgent surgery, and this study shows that perioperative outcomes are also somewhat worse. Thus, definitive surgery performed on a patient who presents emergently with gastric cancer should be considered but may come at the cost of increased perioperative respiratory complications, DVTs, and worse oncologic outcomes.

A Retrospective Analysis of Respiratory Complications under General Anesthesia during EBUS-TBNA.

BackgroundEBUS-TBNA is an established technique for diagnostically sampling intrathoracic masses and lymph nodes. While the procedure is commonly conducted under general anesthesia (GA), little is known regarding the association between anesthetic management and perioperative respiratory complications. Here, we aim to evaluate this association among patients presenting for EBUS-TBNA.Methods586 patients receiving GA for EBUS-TBNA between 2012 and 2018 were retrospectively evaluated. The primary endpoint was the occurrence of perioperative respiratory complications and the secondary endpoint was procedure end to OR exit time (minutes). Respiratory complications were defined as episodes of severe (SpO2 <85%) or prolonged (SpO2<90% for >5 min) hypoxemia, bronchospasm, and postoperative ventilation that could not be directly attributed to procedural invasiveness.ResultsAmong all patients, 79 (13.5%) had respiratory complications. Four patient characteristics were associated with respiratory complications: home oxygen use (OR 2.39; 95% CI 1.26–4.45; P = 0.007), pre-existing respiratory disease (OR 2.01; CI 1.21–3.29; P = 0.005), ASA class (P = 0.03), and albuterol administration intra-operatively (OR 2.22; CI 1.23–3.92; P = 0.007). No anesthetic factors were found to be statistically significant. Procedures with respiratory complications had a longer duration (mean time 88.7 min vs. 111.8 min; P = 0.00009), prolonged time to extubation (mean time 11.9 min vs. 14.2 min; P = 0.039), and stayed in the room longer after extubation (mean time 18.4 min vs. 23.1 min; P = 0.0016). When comparing types of GA, there were no significant differences between volatile anesthetics versus TIVA (12.7% vs. 14.6%, P = 0.54).ConclusionsPre-existing patient characteristics, as opposed to anesthetic factors, are associated with respiratory complications during EBUS-TBNA.

Perioperative management of patients with respiratory failure: methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

Perioperative respiratory complications are one of the main problems in anesthesiology and intensive care, in some areas of surgery they occupy the first place in the structure of all complications of the perioperative period. Initial respiratory failure, as well as the presence of disorders of respiratory functions increase the risk of its development, often leading to an unfavorable outcome of the disease. The recommendations on perioperative management of patients with respiratory failure include modern standards of preoperative assessment of risk factors for respiratory insufficiency, prevention and treatment of perioperative respiratory disorders in Russian Federation. The recommendations describe the principles of diagnosis of respiratory failure, the choice of anesthesia in concomitant lung diseases, the basics of protective ventilation and prevention of postoperative pulmonary complications.&#x0D; &#x0D;

STOP-BANG: a Mandatory Tool for Targeted Respiratory Therapy in Bariatric Patients

Identification of patients with obstructive sleep apnea syndrome and high respiratory risk, optimization of the screening algorithm for these patients and administration of preventive non-invasive lung ventilation, makes it possible to prevent the development of perioperative complications, reduce duration of hospital stay and reduce mortality in patients undergoing surgery and bariatric surgery specifically.The objective: to evaluate the effectiveness of STOP-BANG questionnaire for preventive targeted respiratory therapy to reduce the risk of complications in bariatric patients. Subjects and Methods. We examined 60 patients with BMI above 30 kg/m2 referred to elective secondary surgery, the age made 44.2 ± 10.1 years, 23 men and 37 women. Before the operation, patients underwent STOP-BANG questionnaire survey, night respiratory monitoring with the calculation of the apnea/hypopnea index (AHI) and/or saturation during sleep. The standard preoperative examination included clinical and biochemical analyzes.Results. Based on results of STOP-BANG survey, a correlation was revealed between the score and AHI as well as the score and average saturation. The higher score the patients had according to the STOP-BANG questionnaire, the higher AHI was (r = 0.4748, p = 0.002), and the lower mean SpO2 was (r = -0.6958, p &lt; 0.001). Using the ROC analysis, we chose the optimal threshold value - 4 points according to STOP-BANG questionnaire, where the sensitivity of the method was 93% for the AHI, the specificity was 56%, and for the average saturation it was 100% and 63%, respectively. Of the total number of bariatric patients included in the study, 30% required preventive ventilation. In the high respiratory risk group, no significant intraoperative incidents and deaths were reported by the surgical and anesthetic teams. All patients were discharged on time (5‒7 days). Based on the results, a screening procedure has been offered for bariatric patients with high respiratory risk associated with obstructive sleep apnea syndrome.Conclusion. The STOP-BANG questionnaire is a reliable screening tool for high respiratory risk in morbid obese patients. Early diagnosis of high respiratory risk and implementation of preventive ventilation reduces the incidence of perioperative respiratory and cardiovascular complications.

Can pediatric sleep questions be incorporated into a risk model to predict respiratory complications following adenotonsillectomy?

BackgroundAdenotonsillectomy, one of the most frequent surgical procedures in children, is usually performed for sleep-disordered breathing, a disease spectrum from primary snoring to obstructive sleep apnea. Children undergoing an adenotonsillectomy may be at risk for perioperative respiratory complications, necessitating intervention or escalation of care. However, there is no effective preoperative screening or risk-stratification model for perioperative respiratory complications that incorporates not only clinical history and physical examination but also sleep question responses for children as there is for adults. ObjectivesThe aim of this prospective observational study was to develop a risk-stratification model for perioperative respiratory complications in children undergoing an adenotonsillectomy incorporating not only clinical history and physical examination but also sleep question responses. MethodsA 25-question sleep questionnaire was prospectively administered preoperatively for 1895 children undergoing an adenotonsillectomy from November 2015 to December 2017. The primary outcome measure was overall perioperative respiratory complications, collected prospectively and defined as having at least one major or minor complication intraoperatively or postoperatively. ResultsThe incidence of overall perioperative respiratory complications was 20.4%. Preoperative factors associated with perioperative respiratory complications in the multiple regression model were age, race, preoperative tonsil size, the presence of a syndrome, and the presence of a pulmonary disease. None of the sleep questionnaire responses remained in the multivariable analysis. The area under the ROC curve for the risk stratification model incorporating sleep question responses was only 0.6114% (95% CI: 0.60, 0.67). ConclusionPreoperative sleep question responses may be unable to predict overall perioperative respiratory complications in children undergoing an adenotonsillectomy. A robust risk stratification model incorporating sleep question responses with clinical history and physical examination was unable to discriminate or predict perioperative respiratory complications in our population undergoing an adenotonsillectomy.

The application of patient-centered care bundle significantly reduces incidence of perioperative respiratory complications in hip fracture patients aged 80 and over

This study was designed as a pilot test to analyze the effect of patient-centered care (PCC) bundle intervention on perioperative respiratory complications and other outcomes in hip fracture patients aged ≥80. Between Jan 2018 and Dec 2019, 198 patients comprised the routine care group and 187 comprised the PCC bundle group. After propensity score matching, 151 remained in each group. Incidence of perioperative respiratory complications in the PCC bundle group was significantly lower than in the routine care group (all P < 0.05). Furthermore, significant reductions were observed in surgery delay, length of stay, incidence of arrhythmia, hypoproteinemia, and electrolyte disturbance (all P < 0.05) in the PCC bundle group. Age-Adjusted Charlson Comorbidity Index score was related, but only weakly, to length of stay and the number of perioperative complications. These results suggested that the PCC bundle might be a more suitable care modality for patients ≥80 with hip fracture.

Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study.

PurposeRespiratory complication is one of the major challenges in the treatment of older adults with hip fractures. However, no study so far has investigated the effect of wearing medical masks on the prevention of perioperative respiratory complications in these patients.Patients and MethodsIn this retrospective cohort study, 1016 consecutive patients aged ≥65 years with hip fractures were included and assigned to two groups: the control group and the observation group. The two groups received the same perioperative management modalities. In addition, patients in the observation group were asked to wear medical masks for protection. Data of patients’ demographics, fracture type, surgical methods, comorbidities, the incidence of perioperative respiratory and other complications, and hospital outcomes were collected and compared between the two groups. Subgroup analyses were also performed stratified by fracture types.ResultsA total of 1016 patients (292 females and 724 males) with a mean age of 79.4±7.3 years were analyzed in the study, including 533 in the control group and 483 in the observation group. The overall incidence of perioperative respiratory complication, and the incidence of pulmonary infection, respiratory failure and arrhythmia in the observation group were significantly lower than the control group, especially in winter and spring. There was no difference in other complications, hospital length of stay, and total hospital costs. Further subgroup analyses showed that the incidence of heart failure and arrhythmia in the observation group was lower than that in the control group for patients with femoral neck fractures, which was different from patients with intertrochanteric fractures.ConclusionThe incidence of perioperative respiratory complications, including pulmonary infection and respiratory failure, could be reduced in older adults with hip fractures by strengthening personal protection, including wearing medical masks, especially in winter and spring. Wearing medical masks could also effectively reduce the incidence of perioperative heart failure and arrhythmia in femoral neck fracture patients and do not increase the incidence of other complications and the burden of hospitalization.

Comparison of laryngeal mask airway and endotracheal tube in preterm neonates receiving general anesthesia for inguinal hernia surgery: a retrospective study

BackgroundPreterm neonates are at higher risk of developing inguinal hernia, and have an increased risk of perioperative adverse events. Laryngeal mask airway (LMA) is claimed to be associated to decreasing perioperative respiratory complications compared to endotracheal tube (ETT) in infants under one year of age receiving minor surgery; thus, we conducted a retrospective survey in former preterm neonates below 5000 g to compare the respiratory complications between LMA and ETT in general anesthesia for inguinal hernia surgeries.MethodsThe inclusion criteria were: gestational age at birth under 37 weeks, body weight at surgery below 5000 g, and receiving scheduled inguinal hernia repair under general anesthesia with LMA or ETT. Infants who were dependent on mechanical ventilation preoperatively were excluded. The postoperative respiratory complications including delayed extubation, re-intubation, and apnea within postoperative 24 h were compared between groups.ResultsFrom July 2014 to December 2017, 72 neonates were enrolled into final analysis. There were 57 neonates managed with LMA, and only 15 neonates intubated with ETT during the study period. The gestational age at birth and post-menstrual age at surgery showed no significant difference between groups, although in the ETT group, the body weight at birth and at surgery were lower, and more infants had history of severe respiratory distress syndrome and had received oxygen therapy within two weeks prior to surgery. Surprisingly, none one of the infants developed delayed extubation, re-intubation, or postoperative apnea in the LMA group. In the ETT group, 40 percent of the neonates could not be successfully extubated in the operation theater.ConclusionIn preterm neonates, even in those younger than 52 weeks post-menstrual age who undergoing inguinal hernia repair in their early infancy, LMA appears feasible and safe as the airway device during general anesthesia in specific patient group. However, anesthesiologist might prefer ETT rather than LMA in some complex situation. In neonates with lower body weight at birth and at surgery, and with a history of severe RDS and oxygen-dependence, further prospective study is required.

Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children.

The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. The study was a retrospective cohort study. Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children's Hospital from November 2015 to December 2017. Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. A total of 2437 patients underwent a tonsillectomy at Texas Children's Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

Yarık Damak-Dudak Cerrahisi Sonrası Yoğun Bakım Ünitesinde Takip Edilen Hastaların Perioperatif Komplikasyonları Ve Eşlik Eden Hastalıkları

INTRODUCTION: Cleft lip/palate (CLCP) patients might need postoperative care in Intensive Care Unit (ICU) due to several reasons like difficult airway management, associated abnormalities and perioperative respiratory complications. Our aim was to evaluate the factors associated with difficult airway and need for postoperative ICU follow-up in CLCP patients operated in our institution. METHODS: CLCP patients followed in ICU after surgery between 2005-2013 were retrospectively reviewed. RESULTS: Twenty patients were included to the study. Ten had CLCP together, ten had isolated cleft palate. Difficult intubation was seen in 8 patients. Difficult mask ventilation was seen only in one patient with 22q11 deletion. All patients with difficult intubation had micrognathia. Nasal fiberoptic bronchoscopy was more commonly used in patients with difficult intubation. There was a statistically significant relationship between the presence of any systemic disease and difficult intubation. Main reasons for ICU follow-up were the need for close monitoring and airway related problems. DISCUSSION AND CONCLUSION: Difficult airway is a frequent problem in CLCP patients even in the absence of a diagnosed syndrome. Patients with difficult airway or risk of postoperative airway obstruction could be better followed in ICU during early postoperative period for rapid diagnosis and treatment of possible complications by experienced staff.