Postoperative Airway Complications Research Articles

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study

BackgroundThe video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. MethodsOne hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. ResultsThe first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. ConclusionsThe new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. Trial registrationChinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).

Risk factors of postoperative airway obstruction complications in children with oral floor mass.

The aim of the present study was to explore the risk factors of postoperative airway complications in children with oral floor mass. The first choice of auxiliary examination method for children with oral floor mass is also proposed. This retrospective study included 50 children with floor-of-mouth (FOM) masses. Medical records were reviewed, and information on age of onset, functional impacts present, age at consultation, imaging findings, history of preoperative aspiration, pathology findings, properties of biopsied fluid, treatment modality, postoperative outcomes, and operation were recorded. A total of 20 patients exhibited functional impacts such as difficulty in breathing and feeding. Ultrasound examination was performed in 28 cases; and magnetic resonance imaging, in 38 cases. The diagnosis was lymphatic malformation in 12 cases, developmental cyst in 29 cases, and solid mass in 7 cases. There were 28 cases of surgical resection, 9 cases underwent multiple puncture volume reduction followed by surgery, 11 cases treated using sclerotherapy injection, and 1 case treated using sclerotherapy injection and surgical resection. Young age, functional impact, and high grade of lymphatic duct malformation increased the risk of surgical treatment. B-scan ultrasound is the first choice for the diagnosis of FOM masses in children.

Postoperative Airway Management after Anterior Cervical Spine Surgery: Retrospective Neurosurgical Multicenter Study.

Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation, unplanned reintubation, and/or necessity of tracheostomy. The present study aimed to identify the surgical risks associated with postoperative airway complications in neurosurgical training institutes. A retrospective, multicenter, observational review of data from 365 patients, who underwent anterior cervical spine surgery between 2018 and 2022, at three such institutes was carried out. Postoperative airway complication was defined as either the need for prolonged intubation on the day of surgery or the need for unplanned reintubation. The perioperative medical information was obtained from their medical records. The average age of the cohort was over 60 years, with males comprising approximately 70%. Almost all surgeries predominantly involved anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion, with most surgeries occurring at the level of C5/6. In total, 363 of 365 patients (99.5%) were extubated immediately after surgery, and the remaining two patients were kept under intubation because of the risk of airway complications. Of the 363 patients who underwent extubation immediately after surgery, two (0.55%) required reintubation because of postoperative airway complications. Patients who experienced airway complications were notably older and exhibited a significantly lower body mass index. The results of this study suggested that older and frailer individuals are at an elevated risk for postoperative airway complications, with immediate postoperative extubation generally being safe but requiring careful judgment in specific cases.

To assess the ease of intubation and post-extubation complications of the airway due to the use of microcuffed endotracheal tubes and uncuffed endotracheal tubes

Introduction. Pediatric airway management poses unique challenges due to anatomical differences from adults, rendering children more susceptible to airway complications. Historically, uncuffed endotracheal tubes (ETTs) were preferred in pediatric intubation to minimize risks, but microcuffed (low volume, low pressure) ETTs offer advantages including improved seal and better ventilation efficiency. This study aims to compare the ease of intubation and post-operative airway complications between microcuffed and uncuffed ETTs. Aim. To assess the ease of intubation and post-extubation complications of the airway due to the use of microcuffed endotracheal tubes and uncuffed endotracheal tubes. Methodology. An observational study was conducted on pediatric patients aged 0-10 years undergoing elective surgeries under general anesthesia. Convenience sampling was used to select 54 participants. Patients were divided into two groups: uncuffed endotracheal tube (UG) and cuffed endotracheal tube (CG). Data on intubation attempts and post-operative complications were collected. Results. Baseline characteristics including age, gender, weight, and ASA grade were comparable between groups. Single-attempt intubation success was higher in the uncuffed group (55.6%) compared to the cuffed group (40.7%). Post-operative complications such as respiratory distress, stridor, hypoxemia, and restlessness were more prevalent in the uncuffed group but not statistically significant. Conclusion. This observational study suggests fewer postoperative complications with cuffed endotracheal tube insertion in pediatric patients. However, more research is needed to confirm these findings and explore the efficacy of microcuffed tubes in pediatric anesthesia.

Airway and Anaesthetic Management of Adult Patients with Mucopolysaccharidoses Undergoing Cardiac Surgery.

Background: Mucopolysaccharidoses (MPSs) are rare congenital lysosomal storage disorders due to a deficiency of enzymes metabolising glycosaminoglycans, leading to their accumulation in tissues. This multisystem disease often requires surgical intervention, including valvular cardiac surgery. Adult MPSs have complex airways making anaesthesia risky. Methods: We report novel three-dimensional (3D) modelling airway assessments and multidisciplinary peri-operative airway management. Results: Five MPS adults underwent cardiac surgery at the national MPS cardiac centre (type I = 4, type II = 1; ages 20, 24, 33, 35, 37 years; two males, three females). All had complex airway abnormalities. Assessments involved examination, nasendoscopy, imaging, functional studies, 3D reconstruction, virtual endoscopy, virtual reality and simulation using computerised, physical modelling. Awake oral fibre-optic intubation was achieved via airway conduit. Staged extubation was performed on the first post-operative day under laryngo-tracheoscopic guidance. The post-operative period involved chest physiotherapy and occupational therapy. All patients had safe intubation, ventilation and extubation. Four had good cardiac surgical outcomes, one (MPS type I; age 35 years) was inoperable due to endocarditis. None had post-operative airway complications. Conclusions: Expertise from cardiovascular-heart team, multidisciplinary airway management, use of novel techniques is vital. Traditional airway assessments are insufficient, so ENT input, radiology and computerised methods to assess and simulate the airway in 3D by collaboration with clinical engineering is essential.

Clinical implications of respiratory ciliary dysfunction in heterotaxy patients with congenital heart disease: elevated risk of postoperative airway complications.

Cardiac surgery in Congenital Heart Disease-Heterotaxy (CHD-HTX) patients often leads to increased postoperative airway complications. Abnormal respiratory ciliary function, resembling primary ciliary dyskinesia, has been observed. We expanded the sample size by retrospectively reviewing Ciliary Dysfunction (CD) in CHD-HTX patients to verify the increased risk of post-surgical respiratory complications. We conducted a retrospective review of 69 CHD-HTX patients undergoing cardiac surgery, assessing abnormal respiratory function using nasal nitric oxide (nNO) levels and nasal ciliary motion observed in video microscopy. Data collected included demographics, surgical details, postoperative complications, length of stay, ICU hours, salvage procedures, intubation duration, and mortality. The CD and no-CD cohorts exhibited notable similarities in risk adjustment in Congenital Heart Surgery-1 (RACHS-1) risk categories, age at the time of surgery, and the duration of follow-up evaluations. We observed a trend toward an increased length of post-operative stay in the CD group (15.0 vs. 14.0; P = 0.0017). CHD-HTX patients with CD showed significantly higher rates of respiratory complications (70% vs. 44.4%; P = 0.008). There were no notable variances observed in postoperative hospitalization duration, mechanical ventilation period, or surgical mortality. Our findings suggest that CHD-HTX patients with CD may face an elevated risk of respiratory complications. These results offer guidance for perioperative management and serve as a reference for further pathological studies.

Failed reintubation during resuscitation after posterior occipito-cervical spinal fusion: A case report.

Posterior occipito-cervical spinal fusion (OCF) is a common surgical method for atlantoaxial dislocation, but postoperative airway complications may occur. Reintubation has been reported in the past, but the failure of reintubation is rare. A 54-year-old woman who underwent OCF due to rheumatoid cervical spondylosis and atlantoaxial dislocation. In the postanesthesia care unit, the patient developed upper respiratory tract obstruction after extubation. It is an upper respiratory tract obstruction due to anatomical changes because of surgery. Emergency airway management was activated, but it did not work. Emergency reintubation failed, and the patient was finally saved after tracheotomy. For patients who underwent OCF due to cervical spondylosis caused by rheumatoid arthritis, great attention should be paid to the perioperative airway management, especially during the recovery period. And more important, adequate reintubation preparatory work should be done before extubation.

Tracheostomy experiences in chronic respiratory failure after congenital heart surgery

Introduction&#x0D; A small number of children with repaired congenital heart defects may require a tracheostomy for ongoing ventilatory support. Congenital airway anomalies, laryngomalacia, postoperative airway complications and genetic syndromes associated with airway and facial anomalies, such as DiGeorge Syndrome (22q11 deletion), can be counted among the reasons why patients are unable to be weaned from the ventilator. In this study, we aimed to define the outcomes of patients who required a tracheostomy due to chronic respiratory failure after congenital heart surgery, and the existing risk factors for in-hospital and post-discharge mortality.&#x0D; Materials and methods&#x0D; The files of 1382 patients who underwent surgery due to CHD in the Pediatric Cardiovascular Surgery Clinic in ……………., between February 2019 and February 2023, were retrospectively scanned. Patients’ age, gender, body weight, cardiac diagnosis, surgical intervention, length of stay in the intensive care unit, number of extubation attempts, total length of stay on the ventilator, need for ventilator at discharge, rates of weaning from tracheostomy and time of weaning from tracheostomy and mortality rates, were obtained from patient files and hospital database.&#x0D; Results&#x0D; Tracheostomy was performed in 15 of 1382 patients who underwent surgery during the four year study period. Mean (SD) duration of ventilation prior to tracheostomy was 35 days (IQR= 19 – 47). The median follow up time in patients was 224 days (IQR=116-538). Three patients were decannulated and six had died. Causes of death in six patients included sepsis (2), cardiac instability (1), neurological complications (2) and pulmonary haemorraghia (1). &#x0D; The median time to discharge after tracheostomy in patients was 51 days (IQR= 33.50 – 147). &#x0D; Eight patients (53.3%) were discharged on home ventilation. Causes of deaths were often multifactorial for children who died during their initial hospital stay. Mortality was seen in six patients, a rate of 40%. &#x0D; Conclusion&#x0D; The need for tracheostomy after cardiac surgery plays an important role in early and late mortality in children. Ventilator-dependent chronic respiratory failure is the most common cause of childhood tracheostomies. We believe that determining the optimal timing for tracheostomy in the pediatric population will be effective in reducing prolonged ventilation and tracheostomy-related morbidities.

Effect of Fixed Tracheal Cuff Volume vs Fixed Tracheal Cuff Pressure on Hemodynamic Parameters and Postoperative Airway Complications, A Prospective Randomized Control Trial in a Tertiary Care Hospital

Background: The current study is aimed to compare the effect of fixed cuff volume and fixed cuff pressure technique on hemodynamic parameters and on postoperative complications.&#x0D; Methods: The prospective, randomised, controlled study was conducted in a tertiary care hospital with 100 patients aged between 18 to 60 yrs. The patients who are undergoing for elective surgeries under general anaesthesia were enrolled after obtaining ethical committee approval. Patients were randomized based on computer generated random numbers into two groups, fixed volume (7ml) group (group V, n-50) and fixed cuff pressure group (group P, n-50). The ETT cuff was filled with 7 ml of air in the fixed volume technique, and in the fixed cuff pressure group -cuff pressure was maintained at 20 cmH2O, after intubation. Tracheal tube cuff pressures were measured by AMBU cuff pressure gauge manometer. Hemodynamic parameters SBP, DBP, MAP and PR were noted at the time of cuff inflation, after extubation in the both the groups. Post-operative sore throat, hoarseness and cough was assessed at the time of extubation in the both the groups.&#x0D; Results: Mean age in both the groups was 41 years. Statistical significance (P&lt; 0.0001) was observed in Group P in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, HR whereas no significance was seen in group V. The percentage of post-operative complications like hoarseness, cough, sore throat, and dysphagia were seen to be less in group P when compared to group V.&#x0D; Conclusion: With present data we could conclude that the fixed minimal cuff pressure (20 mm H2O) is an ideal and reliable technique in reducing the post-operative complications along with maintenance of hemodynamic parameters.&#x0D;

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

BackgroundThe incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation.MethodsOne hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed.ResultsCompared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E).ConclusionsCompared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Incidence, risk factors, and clinical characteristics of airway complications after lung transplantation

Airway complications may occur after lung transplantation and are associated with considerable morbidity and mortality. We investigated the incidence, risk factors, and clinical characteristics of these complications. We retrospectively reviewed the medical records of 137 patients who underwent lung transplantation between 2008 and 2021. The median follow-up period was 20 months. Of the 137 patients, 30 (21.9%) had postoperative airway complications, of which 2 had two different types of airway complications. The most common airway complication was bronchial stenosis, affecting 23 patients (16.8%). Multivariable Cox analysis revealed that a recipient’s body mass index ≥ 25 kg/m2 (hazard ratio [HR], 2.663; p = 0.013) was a significant independent risk factor for airway complications, as was postoperative treatment with extracorporeal membrane oxygenation (ECMO; HR, 3.340; p = 0.034). Of the 30 patients who had airway complications, 21 (70.0%) were treated with bronchoscopic intervention. Survival rates did not differ significantly between patients with and without airway complications. Thus, our study revealed that one fifth of patients who underwent lung transplantation experienced airway complications during the follow-up period. Obesity and receiving postoperative ECMO are risk factors for airway complications, and close monitoring is warranted in such cases.

The Comparison Between Inhalation and Total Intravenous Anesthesia Effect on Voice With Supraglottic Airway Devices for Short-term Anesthesia

Supraglottic airway devices (SADs) are a good alternative to endotracheal intubation (ETI) in short-term anesthesia applications since they have advantages including easy application, lower cost, enabling spontaneous ventilation. Total intravenous anesthesia (TIVA) and desflurane anesthesia allowing rapid recovery are anesthesia methods to be selected. Inhalation anesthesia by desflurane may cause adverse effects on airway mucosa and vocal cord functions. The aim of the present study was to compare the effect of the chosen anesthesia method on voice in gynecological patients who underwent short-term anesthesia with SADs. Seventy four patients whom short-term surgical procedure was planned in the Gynecology and Obstetrics Clinic were randomized into two groups for desflurane anesthesia (group D) and TIVA (group T). Voice recording was performed through larynx examination before anesthesia. Perioperative hemodynamic parameters, airway complications and postoperative airway complications were recorded. Laryngeal examination and voice recording were performed for the second time after 24 hours following the anesthesia procedure. Acoustic voice analysis of the patients was evaluated through the Praat program. The conditions including sore throat, dysphagia, and hoarseness were investigated after the anesthesia. Acoustic and aerodynamic properties of the voice, airway complications and pharyngolaryngeal complaints related to the use of SADs were compared in the patients. There was not any significant difference between the groups for demographic data. The SADs type and size have similar characteristics. No significant difference was detected between Group T and Group D for anesthesia duration (P=0.964). Both anesthesia methods cause similar effects on pharyngolaryngeal functions and voice. No significant difference was found between Group T and Group D in parameters other than the shimmer value of acoustic analysis. A statistically significant increase was observed in the Shimmer variable of group D (P < 0.05). When group T and group D were compared, there was not any significant difference in terms of airway complications, sore throat, dysphagia, and hoarseness. The TIVA and desflurane anesthesia presented similar clinical effects on voice and pharyngolaryngeal morbidity in the short-term gynecological operations through SADs. The increased shimmer value of acoustic voice analysis in Group D suggests that desflurane anesthesia may cause clinically insignificant deterioration on the voice. Further comprehensive studies are needed in order to demonstrate the effect of anesthetic agents on larynx functions in patients whom SADs is used.

Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial.

The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change. To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation. In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH2O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH2O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured. The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH2O) than in the cylindrical cuff (25.5 ± 0.8 cmH2O) after head and neck extension (P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) (P < 0.001). The incidence of postoperative airway complications was comparable between two groups. After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.

Assessment of socioeconomic disadvantage in laryngotracheoplasty outcomes among pediatric patients.

To determine whether socioeconomic disadvantage impacts outcomes after pediatric laryngotracheoplasty. Case series with chart review. All laryngotracheoplasty procedures at a tertiary children's hospital between 2010 and 2019 were included. Primary zip code determined Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure, and children were grouped based on less or more community disadvantage. Primary outcomes included complication and decannulation rates. Eighty-four procedures were included with 69% (58/84) double-stage and 31% (26/84) single-stage reconstructions. Median age at surgery was 3.2 (IQR 2.2-4.9) years, 56% (47/84) were male, and median gestational age was 25 (IQR 24-28) weeks. Children from more disadvantaged communities represented 67% (56/84) of surgeries and were more likely to have higher grade stenosis (89% vs. 64%, P=.02). Postoperative airway complications (20% vs. 18%, P=.99), non-airway complications (14% vs. 18%, P=.75), and total length of stay (7 vs. 6 days, P=.26) were not impacted by ADI grouping. While children from higher community disadvantage were just as likely to be decannulated after double stage surgeries (76% vs. 76%, P=.99), it more often took longer than six months to achieve (90% vs. 61%, P=.04). Community disadvantage is associated with higher grade airway stenosis and longer times to successful decannulation in children requiring expansion airway surgery. Encouragingly, ADI grouping did not impact complication and decannulation rates. Continued work is needed to understand how socioeconomic metrics influence pediatric open airway surgery.

Risk Factors for Prolonged Mechanical Ventilation and Delayed Extubation Following Bimaxillary Orthognathic Surgery: A Single-Center Retrospective Cohort Study

Background: Bimaxillary orthognathic surgery bears the risk of severe postoperative airway complications. There are no clear recommendations for immediate postoperative follow-up and monitoring. Objective: to identify potential risk factors for prolonged mechanical ventilation and delayed extubation in patients undergoing bimaxillary orthognathic surgery. Methods: The data of all consecutive patients undergoing bimaxillary surgery between May 2012 and October 2019 were analyzed in a single-center retrospective cohort study. The clinical data were evaluated regarding baseline characteristics and potential factors linked with delayed extubation. Results: A total of 195 patients were included; 54.9% were female, and the median age was 23 years (IQR 5). The median body mass index was 23.1 (IQR 8). Nine patients (4.6%) were of American Society of Anesthesiologists Physical Status Classification System III or higher. The median duration of mechanical ventilation in the intensive care unit was 280 min (IQR, 526 min). Multivariable analysis revealed that premedication with benzodiazepines (odds ratio (OR) 2.60, 95% confidence interval (0.99; 6.81)), the male sex (OR 2.43, 95% confidence interval (1.10; 5.36)), and the duration of surgery (OR 1.54, 95% confidence interval (1.07; 2.23)) were associated with prolonged mechanical ventilation. By contrast, total intravenous anesthesia was associated with shorter ventilation time (OR 0.19, 95% confidence interval (0.09; 0.43)). Conclusion: premedication with benzodiazepines, the male sex, and the duration of surgery might be considered to be independent risk factors for delayed extubation in patients undergoing bimaxillary surgery.

Recognising and managing postoperative airway complications: a patient safety quality improvement project

Within our institution, surgery that may cause postoperative airway complications is frequently performed by several surgical specialties. A strategy to improve awareness and management of these associated complications was developed after several clinical incidents involving delayed recognition of postoperative anterior neck haematomas (ANHs), including a cardiac arrest in a patient who had deteriorated over several hours after right partial glossectomy and selective neck dissection.

Bronchial Suturing Techniques After Lung Transplant: A Single Surgeon Analysis

<h3>Purpose</h3> In lung transplantation (LTx) postoperative airway complications can increase morbidity and mortality. Current literature offers little analysis examining a single surgeon's work. We assessed postoperative bronchial complication rates, treatments, and survival outcomes in LTx performed by a single surgeon and stratified data by suturing technique. <h3>Methods</h3> A single surgeon's LTx (n=444) were analyzed from 901 total LTx done between Feb 2012- March 2021. Continuous suturing (CS) and intermittent suturing (IS) techniques were compared. CS technique was done with 3/0 polypropylene suture on an SH needle. IS is used on the membranous portion of the anastomosis and multiple interrupted 3/0 polypropylene sutures are used for the cartilaginous portion. Demographic and clinical data, post op bronchial complications, and their interventions were compared and categorized. Survival was compared with Kaplan-Meier curves and log-rank tests. Cox regression analysis was run using all variables to assess impact on survival. P values <0.05 were considered significant. <h3>Results</h3> Of 444 patients in this single surgeon study, 259 received IS and 185 received CS. ECMO was utilized in 19 CS patients vs 18 IS patients IS (p = 0.371). There was no significant difference in post-transplant complication rates (p = 0.629). The most common complications were stenosis (CS14; IS-19), ischemia (CS 0; IS-7), and stenosis + malacia + dehiscence (CS 4; IS9). Treatment for bronchial complications was varied, including dilation and stent placement when indicated for the complications of both CS and IS. Kaplan-Meier curve showed no difference in survival outcomes between groups (p = 0.562). Cox regression analysis with all variables showed that the type of induction (Hz 1.48; p=0.01) and CPB (Hz 1.44; p=0.024) had a significant effect on survival. <h3>Conclusion</h3> Analysis of suturing techniques in a single surgeon at a single center showed comparable survival outcomes, bronchial complication rates, and follow up treatments between IS and CS techniques.

P80. ANALYSIS OF ROUTINE INTENSIVE CARE UNIT ADMISSION FOLLOWING PALATOPLASTY IN PATIENTS WITH ROBIN SEQUENCE

PURPOSE: Management of neonatal upper airway obstruction (UAO) in patients with Robin Sequence (RS) may impact the need for intensive care unit (ICU) care following primary palatoplasty (PP) later in life. The current study investigated the necessity for ICU admission after PP in patients with RS, based upon prior upper airway management. METHODS: We conducted a review of patients with RS who underwent PP between 2006-2020. Patient demographics, perioperative characteristics, ICU admission, and postoperative airway and non-airway complications were compared, based on prior airway management, as determined by multidisciplinary team evaluation and consensus. RESULTS: Fifty-eight patients were included. Median [IQR] age at PP was 12.9 [10.8,15.6] months. Three groups were compared: Conservative (n=30), tongue-lip adhesion (TLA) (n=14) and mandibular distraction osteogenesis (MDO) (n=14). While ICU admission (conservative, 33.3%; TLA, 78.6%; MDO, 78.6%; p=0.002) and overall airway-related complications were significantly higher in patients with prior TLA and MDO (conservative, 26.7%; TLA, 64.3%; MDO, 57.1%; p=0.034), rates of major post-PP airway events (prolonged intubation >4h, unexpected ventilatory support via pre-existing tracheostomy, or reintubation) that would have required ICU care were low and insignificant between groups (0-14.3%; p>0.05); post-hoc analysis documented significant differences only in overall airway events between TLA vs. conservative airway groups (64.3% vs. 26.7%; p=0.02). CONCLUSION: ICU care after PP in patients with RS may not be necessary for infants who had appropriate management of neonatal UAO, potentially preserving resources for patients with greater need. Special attention may be prudent for post-PP patients who underwent neonatal TLA.

Comparison Between The Effects of Betamethasone Gel And Lidocaine Jelly To Reduce PostOperative Tracheal Tube Related Airway Symptoms

Objective: To determine the role of betamethasone gel and lidocaine jelly on reducing the post-operative airway complications related to tracheal tube.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Anesthesia, Liaquat National Hospital, from Jul 2019 to Jan 2020.&#x0D; Methodology: A total of 150 patients were randomly assigned into three different groups; group-B (0.05% betamethasone gel), group-L (tube lubricated with 2% lidocaine jelly) and group-C (intubated with un-lubricated tubes). Patients were assigned by using lottery method, which was carried out by a research assistant who was not involved in the study. There were 50 patients in each group.&#x0D; Results: Post-operative sore throat and post-extubation cough at 24-hours were statistically insignificant (p&gt;0.05) between groups while hoarseness of voice at 24-hours postoperatively was significant (p&lt;0.05) in all the groups. The overall difference for severity of postoperative sore throat, hoarseness of voice and post-extubation cough at24 hours in the groups B, L, and C were statistically significant (&lt;0.05).&#x0D; Conclusion: The application of betamethasone gel on endotracheal tube before intubation reduces the post-extubation cough, severity of post-operative sore throat, hoarseness of voice and post-extubation cough in comparison with the application of lidocaine jelly and un-lubricated ETT.