Postoperative Airway Obstruction Research Articles

Association between Oral Cancer Surgery and Postoperative Airway Obstruction: A retrospective study

ObjectivePredicting postoperative airway obstruction during oral cancer surgery is difficult. We aimed to investigate the relationship between postoperative airway obstruction and surgery in patients. MethodsPatients (n=100, men: 72, women: 28) with oral malignancies who underwent surgery between January 2020 and December 2022 were included. The outcome was postoperative airway obstruction. Age, sex, alcohol, smoking history, BMI, tumor site, T and N classification, stage, surgical method, lymphatic invasion, vascular invasion, perineural invasion, DOI, airway management, occurrence and duration of postoperative airway obstruction were investigated. We defined airway obstruction as confirmed symptoms such as dyspnoea and wheezing, drop in SpO2 below 90%, stridor auscultation and pharyngeal stenosis by endoscope.The relationship between airway obstruction and patient characteristics was analyzed using Fisher's exact test. The Kaplan–Meier method was used to assess onset of airway obstruction, and the time to onset of airway obstruction was compared using the log-rank test. Airway obstruction and surgery-related factors were evaluated using Cox regression models. ResultsAirway obstruction occurred in 6 patients within 12hours. Multivariate analysis revealed that age >65 years, lymphatic invasion and DOI (cut-off value: 7.00mm) were independent risk factors for occurrence of airway obstruction. ConclusionLocal resection of tumors ≥7mm in DOI is associated with airway obstruction owing to factors such as swelling associated with deep resection. Age, lymphatic invasion are also associated with airway obstruction, requiring ward management according to the protocols of each institution with attention to postoperative hematoma and edema that may cause airway obstruction.

Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report

BackgroundIntraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring.Case PresentationA 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated.ConclusionsAcute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue’s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.

The Impact of Adhesions on Nasal Airflow: A Quantitative Analysis Using Computational Fluid Dynamics.

Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated. We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects. CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject's NA-free control model. 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs (P < .001) and 0.63 °C for the internal valve NAs (P < .001). NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.

Indications for resection of parapharyngeal space tumors by transoral robotic surgery and prevention and treatment of complications

Objective:This study investigated the clinical indications, prevention and management of common complications of TORS resection of parapharyngeal space tumors. Methods:The clinical data of 23 patients with parapharyngeal space tumors treated with TORS in the Eye & ENT Hospital of Fudan University from July 2020 to February 2022 were retrospectively analyzed. The surgical methods were divided into simple TORS surgery and TORS combined endoscopic or cervical surgery. The surgical incision can be directly sutured or partially sutured. If the surgical cavity is below the oropharyngeal plane and there is a risk of airway compression, preventive tracheotomy would be performed. No drainage（15 cases） or transnasal negative pressure drainage tube（8 cases） was placed in the operation cavity. In 17 cases, tumors were located between the top of nasopharynx and the lower boundary of oropharynx and these patients underwent simple TORS surgery; one case received combined cervical and endoscopic surgery, as the tumor was located near the skull base with unclear boundary with the deep lobe of parotid gland; five cases underwent combined endoscopic surgery, as the tumor reached the upper part of the nasopharynx or the outer part of the parapharyngeal space. Results:One case underwent emergency hemostasis for postoperative bleeding, and three cases underwent puncture and drainage for postoperative effusion. No complication occurred such as postoperative infection and airway obstruction. The healing grade of surgical incision and surgical cavity in transnasal drainage group was significantly better than that in non-drainage group. Conclusion:TORS operation is a safe and minimally invasive method in treating parapharyngeal space tumors with appropriate size and location. Postoperative effusion is a common complication after TORS. In case that surgical cavity extends to the deep parapharyngeal space or the lower part of the surgical cavity is beneath the surgical incision, the placement of transnasal negative pressure drainage tube after operation can improve postoperative recovery and reduce the incidence of complications such as effusion and infection.

Unexpected Beneficial Effect of Dexamethasone Administration after Septoplasty Procedure: As Prospective Cohort Audit

Background and Objectives: Septoplasty is one of the most common surgical procedures in specialty of otorhinolaryngology. Therefore, there are frequent thoughts regarding this procedure to improve its conditions from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of big issues regarding this procedure is the post-operative sequel and complications namely post-operative pain, oro-facial edema, air way obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation. Therefore, this study was conducted prospectively to confirm the effect of intravenous administration of dexamethasone on outcomes of this procedure as compared to the effect of oral administration of ketoprofen as well as paracetamol after septoplasty procedure. Patients and Methods: Two- thousands and two- hundred thirteen patients aged from 4 years to 65 years presented at ENT department-Althowra central teaching hospital as well as Altarahom private clinic-elbyda city-Libya at period in between September 2005 to January 2022 as cases of DNS with variable patterns of septal deformities for septoplasty. Five hundred thirty- one patients were received oral paracetamol who represent group-A, 753 received oral ketoprofen that constitutes group-B, while remaining 929 were administrated by intravenous dexamethasone and classified as group-C. As prospective analytic study, three groups compared in relation to significant postoperative complications risk namely post-operative pain, oro-facial edema, airway obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation. In addition, these groups compared for any significant difference regarding the period of postoperative hospitalization, which can be used, as objective indicator to measure the postoperative morbidity rate. Results: Dexamethasone as well as ketoprofen administration caused significant improvement in pain intensity as compared to paracetamol group. On the other hand there was significant reduction in the incidence of post-operative oro-facial edema, air way obstruction, epistaxis, nausea and vomiting, nasal obstruction, atrophic rhinitis, induction of allergic rhinitis, septal perforation and synachia formation among group-B and C as compared to group-A. Conclusion: Dexamethasone can be considered as potent analgesic drug after septoplasty procedure and in same time, it plays significant role in the improvement of outcomes of this common procedure as compared to the other commonly used non-steroidal anti-inflammatory drugs.

Comparison of harmonic shears, diode laser, and scissor cutting and suturing for caudal palatoplasty in dogs with brachycephalic obstructive airway syndrome

Traditionally, staphylectomy has been performed using scissors cutting and suturing. Alternative surgical techniques such as staphylectomy with monopolar electrocoagulation, CO2 or diode laser, bipolar vessel sealing device and harmonic shears have also been described. The purpose of this prospective study was to compare the difference in surgical time, intraoperative haemorrhage and histological damage between staphylectomy performed with harmonic shears (HSS), diode laser (DLS) and traditional scissor ‘cutting and suturing’ technique with Metzenbaum scissors (SIS). Group HSS included 17 dogs, whereas Group DLS and Group SIS included 10 dogs each. Double masked histological evaluation was performed on the excised specimens.The harmonic shears resulted in the shortest surgical times (HSS 46 s, DLS 300 s, SIS 360 s; P < 0.001). There was a difference in the intraoperative haemorrhage among the three techniques; intraoperative haemorrhage did not occur in HSS and DLS groups. HSS was associated with more frequent damage involving the connective tissue (P = 0.001), muscle (P = 0.038), salivary gland tissue (P < 0.001), but less oedema was observed (P < 0.001). HSS was the fastest of the techniques evaluated for caudal elongated soft palate resection, resulting in less tissue oedema, and no intra-operative haemorrhage. These characteristics might result in reduced postoperative swelling and airway obstruction compared to other techniques.

Management of Complications Associated With Gorham-Stout Disease: Case Report and Review of the Literature

This case report describes the course of a patient diagnosed with Gorham-Stout Disease and reviews known complications and treatment options for this rare condition. An emphasis is placed on potential multi-systemic complications that may occur including surgical complications, obstructive sleep apnea, post-operative airway obstruction, respiratory failure and cardiac arrest.

Peri operative airway and respiratory complications in children undergoing cleft lip and palate repair at a tertiary institute: An observational study

Introduction: Airway related problems have always been a major concern in paediatric patients more so in patients presenting with cleft lip/palate. Objective: Our aim was to determine the incidence of various types of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair and their management at our tertiary care centre. Methodology: This prospective observational study was conducted over a period of 18 months in 50 ASA I and II paediatric patients (age group new born to 12 years) undergoing cleft lip/palate surgery. Complications during induction, intubation and postoperative period were noted. Results: Difficult laryngoscopy in 10% (n=5) patients & difficult intubation in 4% (n=2) patients were noted. No incidences of failed intubation were seen. Tube disconnection (n=1) and tube repositioning (n=2) after mouth gag placement. Desaturation occurred in 4% (n=2) patients, one during difficult intubation and one after mouth gag placement. One patient had laryngospasm during intubation. One patient had an episode of post extubation breath holding spell. One patient had tongue fall postoperatively. Conclusion: Airway and respiratory complications can be encountered during cleft lip and palate surgeries. Preoperative assessment and identifying any airway problems, congenital anomalies and comorbid conditions is important. Adequate preparation for difficult airway should be done before induction of anaesthesia to avoid morbidity and mortality. Intraoperative airway complications due to the shared airway have to be anticipated. Postoperative airway obstruction may be encountered and has to be treated prophylactically.

Comparing the Outcomes of Thyroid Surgical Procedures for Benign Diseases with Expertise of the Surgeon in a Tertiary Care Hospital in Rawalpindi, Pakistan

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P&lt;.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P&lt;.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure\u2014a case report

BackgroundDrugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect.Case presentationA 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed.ConclusionNeuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.

Evaluation of Scoring Systems for Airway Management After Oral Cancer Surgery: A Retrospective Study

Postoperative airway obstruction following oral cancer surgery is difficult to predict. Scoring systems used to assess the need for tracheotomy use risk factors as criteria. We aimed to examine whether these clinical scoring systems can predict airway obstruction following oral cancer surgery. We assessed 95 patients who underwent oral cancer surgery without tracheotomy under general anesthesia between January 2007 and April 2019. We reviewed multiple factors from the patients' medical records, including age, sex, tumor site, body mass index, tumor stage, type of surgery, airway management method, Cameron and Gupta scores, and postoperative airway complications. Tumors were located in the maxilla (n = 14), buccal mucosa (n = 13), mandible (n = 14), floor of the mouth (n = 6), and tongue (n = 48). Twenty-seven patients (28.4%) were graded as Stage 1, 37 patients (38.9%) as Stage 2, 9 patients (9.5%) as Stage 3, and 3 (3.2%) patients as Stage 4. Nine patients (9.5%) had local recurrences, and ten patients (10.5%) had neck metastases. Postoperative oxygen administration alone failed to improve dyspnea in 4 patients (4.2%). The median Cameron scores between patients with and without airway trouble were not significantly different (P = 0.226). However, a significant difference was observed in median Gupta scores between patients with and without airway trouble (P = 0.01). We created a receiver operating characteristic curve to predict postoperative airway trouble based on the preoperative Gupta score; the area under the curve was 0.856 (95% confidence interval: 0.61-1). A Gupta score cutoff value of 3.0 had a sensitivity of 92.3% and specificity of 75.0%. Screening based on the Gupta score appears to be effective in predicting postoperative airway obstruction. We propose that this screening tool can be used to better plan tracheotomy and other airway management strategies during preoperative patient assessment.

Postoperative complete airway obstruction: Could compliance with the WHO surgical safety checklist have avoided the anaesthesiologist's nightmare?

Postoperative complete airway obstruction: Could compliance with the WHO surgical safety checklist have avoided the anaesthesiologist's nightmare?

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.

Airway Management Strategy Using Seldinger Minitracheostomy Kit to Prevent Airway Obstruction after Oral Cancer Surgery: A Retrospective Study.

A minitracheostomy (MTS) is performed after surgery for oral cancer at our institution in patients who are at risk of postoperative airway obstruction. The aim of this study was to evaluate outcomes of preventive airway management with this procedure. A total of 105 patients undergoing preventive airway management with a Seldinger MTS kit after oral cancer surgery between October 2014 and March 2020 were enrolled. Information on patient characteristics, time required for the MTS, duration of tracheal cannula placement, and MTS-related complications was obtained from both the medical and anesthesia records. In addition, the numbers of postoperative instances of tracheotomy between April 2009 and September 2014 and extubation between October 2014 and March 2020 were also counted for a comparison. The time required for an MTS was 3.2±2.6 min. Minor complications, including mild subcutaneous or mediastinal emphysema and bleeding, were found in 5 patients, but all recovered in a short time. The median duration of tracheal cannula placement was 2 days, with a range of from 0 to 8 days. A total of 348 oral cancer surgeries were performed between April 2009 and September 2014. Among patients undergoing these procedures, 111 underwent a tracheostomy (32%), 235 extubation (68%), and 2 sustained intubation. A total of 580 oral cancer surgeries were performed between October 2014 and March 2020. Here, 121 patients underwent a tracheostomy (21%), 105 an MTS (18%), and 354 extubation (61%). The results suggest that an MTS can be performed safely and smoothly with no significant complications. They also suggest that an MTS reduces the need for a full tracheostomy and the risk of airway obstruction after extubation. We conclude that airway management strategy with an MTS is a useful option in preventing airway obstruction following oral cancer surgery.

Augmentation of the posterior pharyngeal wall with autologous tragal cartilage for management of velopharyngeal valve insufficiency in adults

ObjectiveThe study aims to evaluate posterior pharyngeal wall augmentation using autologous tragal cartilage graft in adults with velopharyngeal valve insufficiency (VPI). MethodsThe study included 23 patients with VPI (grade I, II, III), with ages ranging from 19 to 45 years. Six patients had previously undergone simple palatoplasty for cleft palate, 8 patients had previously undergone adenotonsillectomy and 9 patients had previously undergone uvulopalatopharyngoplasty (UPPP). The procedure was done by implanting a piece of autologous tragal cartilage in the posterior pharyngeal wall. Patients were followed up for 24 months postoperatively. The evaluation of percent of speech intelligibility and grade of the closure of the velopharyngeal valve using video-nasopharyngoscopy was evaluated preoperatively and postoperatively. ResultsHighly statistically significant improvement in the grade of the closure of the velopharyngeal valve (P = 0.009) and percent of intelligibility (P = 0.001) was found after surgery. There were no postoperative airway obstruction or sleep apnea. ConclusionAugmentation of the posterior pharyngeal wall using tragal cartilage is an effective, safe and physiological surgical procedure in the management of VPI in adults who suffered hypernasality following palatal and oropharyngeal surgeries.

Predictive Nomogram for the Necessity of Tracheotomy During Oral and Oropharyngeal Cancer Surgery.

The individualized risk of airway obstruction after head and neck cancer surgery is unclear, especially oral and oropharyngeal cancer. The study aimed to establish an individualized predictive model for the necessity of temporary tracheotomy in these patients. Patients who underwent oral and oropharyngeal cancer surgery from 1999 to 2019 were retrospectively reviewed. A nomogram was developed and validated in patients treated from 1999 to 2009 and 2010 to 2019, respectively. In total, 1551 patients were included. Oropharyngeal cancer, large tumor, midline crossing, preoperative radiation, mandibulectomy, flap reconstruction, and neck dissection were independent risk factors of postoperative airway obstruction in the training group (n = 707). A nomogram incorporating these factors had a C-index of 0.931 and was validated in the testing group (n = 844) (C-index, 0.918). Good calibration curves were observed in both groups. The nomogram successfully predicted the individual risk of postoperative airway obstruction for patients with oral and oropharyngeal cancer. 4. Laryngoscope, 131:E1489-E1495, 2021.

Solving the problem of post-operative airway obstruction in Nasal/Sinus Surgery

Sinus surgery, septoplasty—with or without turbinate reduction—and rhinoplasty are among the most common surgical procedures performed by our specialty.

Palatal Re-Repair With Double-Opposing Z-Plasty in Treatment of Velopharyngeal Insufficiency of Patients With Unilateral Cleft Lip and Palate.

Velopharyngeal insufficiency (VPI) is a common problem after cleft palate repair that is often related to palatal shortening and insufficient levator reconstruction. For VPI correction in our cleft center, palatal re-repair with double-opposing Z-plasty is the standard operation. To assess the efficacy of double-opposing Z-plasty in treatment of VPI after primary surgery for unilateral cleft lip and palate (UCLP). This retrospective analysis comprised 109 consecutive UCLP patients born between 1997 and 2014 with VPI that required re-operation, and were operated on by 2 highvolume cleft surgeons, followed by perceptual and instrumental (Nasometer) evaluation of velopharyngeal competence (VPC). Preoperatively, VPI was severe in 96% (105 of 109) and mild-to-moderate in 4% (4 of 109). Median age at surgery was 5.6 years (range 2.8-21.9). Postoperatively, 84% of patients achieved adequate VPC: 65% (71 of 109) were competent and 19% (21 of 109) borderline competent. Postoperative adequate VPC was 89% (70 of 79) in nonsyndromic Finnish patients, 50% (4 of 8) in syndromic patients, and 82% (18 of 22) in adoption children. Compared to Finnish nonsyndromic patients, patients with syndrome had more residual VPI (P = 0.003), but no statistically significant difference existed for adoption patients (P = 0.251). Complications of the double-opposing Z-plasty included hemorrhage, postoperative mild airway obstruction, and wound-healing problems, each arising in 2 (1.8%) patients. Fourteen (13%) patients needed a second VPI operation. Double-opposing Z-plasty seems to be a good and safe treatment option for VPI in patients with previously repaired UCLP with a success rate of 84%.

The effects of doxapram on time to tracheal extubation and early recovery in young morbidly obese patients scheduled for bariatric surgery: A randomised controlled trial.

Bariatric surgery is a well established treatment of the obese. Postoperative respiratory failure and airway obstruction after bariatric surgery can often be attributed to the residual depressant effects of anaesthetics, sedatives and opioids. Peri-operative management of morbidly obese patients is still a concern for operating room professionals. The evaluation of the effects of doxapram on the outcomes of general anaesthesia following bariatric surgical procedures in the morbidly obese. A single-blind randomised controlled trial with two parallel arms. A tertiary care teaching hospital, Tehran, Iran, from 2017 to 2018. In total, 100 patients (69 women) with at least class two obesity were included in two groups of equal sizes and underwent bariatric surgery. The primary outcome was the time from the administration of doxapram to tracheal extubation. Secondary outcomes included vital signs and variables including peak expiratory flow rate, time to return to spontaneous breathing, time to eye-opening and hand-squeezing on the commands, and time to recovery. Both groups underwent general anaesthesia. The intervention group received a single dose of doxapram 1 mg kg ideal body weight, immediately after reversal of neuromuscular blockade and after discontinuation of all anaesthetics. Doxapram decreased time to extubation, time to eye-opening and hand-squeezing, shortened recovery time and lowered end-tidal CO2 significantly (all P < 0.001). Moreover, it increased peak expiratory flow rate, oxygen saturation, temperature, heart rate and blood pressure (all P < 0.001). The two groups were similar in the bispectral index and mean arterial pressure (both P > 0.05). None of our participants had complications attributable to doxapram. The postoperative use of doxapram improves peak expiratory flow rate, and decreases respiratory complications of anaesthesia during recovery in the morbidly obese undergoing bariatric surgery. Doxapram is well tolerated in young ASA physical status classes 1 to 2 morbidly obese patients; however, the anaesthesiologist should cautiously evaluate the vital signs for at least half an hour following the administration of doxapram. Iranian Registry of Clinical Trials (IRCT) http://www.irct.ir/ number IRCT2017060712203N9.

Outcome of temporary tracheostomy tube‐placement following surgery for brachycephalic obstructive airway syndrome in 42 dogs

To describe the use, complications and outcome of temporary tracheostomy tube placement as part of the management of acute upper airway obstruction in the postoperative period following multi-level airway surgery in patients with brachycephalic obstructive airway syndrome. Retrospective review of records of dogs surgically treated for brachycephalic obstructive airway syndrome that had a temporary tracheostomy tube placed in the postoperative period. Forty-two dogs were included. Median duration of temporary tracheostomy tube placement was 2 days (range 1 to 7). The major complication rate was 83.3%, minor complication rate was 71.4%, resulting in an overall postoperative complication rate of 95.2%. The most common postoperative complications were tracheostomy tube obstruction (32/42), cough (25/42) and tracheostomy tube dislodgement (16/42). Temporary tracheostomy tube management was classified as successful in 97.6%. Dyspnoea was the most common clinical sign in the short-term postoperative follow-up period, while dyspnoea and increased upper respiratory tract noise were the most common clinical sign in the long term. The median duration of follow-up was 251 days. In an appropriate clinical setting, placement of temporary tracheostomy tubes following multi-level airway surgery for brachycephalic obstructive airway syndrome is a useful strategy to manage postoperative airway obstruction, carrying a low mortality rate, and with a complication rate similar to that found in previous reports.