scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Respiratory Complications ◽  
Probability Of Success ◽  
Intracranial Pressures ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia. In the vast majority of cases, this is carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. This smooth emergence is particularly important for procedures that require maintenance of stable levels of intraocular and intracranial pressures, such as in neurologic, ophthalmic, and head-and-neck surgery [1]. Reluctance to performing deep extubation in adults, even in appropriate circumstances, is common and likely derives both from concerns for potential respiratory complications [2] and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was low and all easily reversible. And patient factors and extubation conditions may influence probability of success in deep extubation.

scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

scholarly journals Incidence of airway complications associated with deep extubation in adults

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). Conclusions The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults.Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

The Combitube in Elective Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Luis A. Gaitini ◽  
Sonia J. Vaida ◽  
Somri Mostafa ◽  
Boris Yanovski ◽  
Milian Croitoru ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Airway Device ◽  
Spontaneous Ventilation ◽  
Mechanically Ventilated ◽  
Entire Duration ◽  
Duration Of Surgery ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

Cardiovascular and respiratory complications after major head and neck surgery

Head & Neck ◽  
2006 ◽  
Vol 28 (7) ◽  
pp. 595-602 ◽  
Author(s):  
Dirk R. Buitelaar ◽  
Alfons J. M. Balm ◽  
Ninja Antonini ◽  
Harm van Tinteren ◽  
Johannes M. Huitink
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Respiratory Complications

Surgical Site Infections in Major Head and Neck Surgeries Involving Pedicled Flap Reconstruction

2016 ◽  
Vol 126 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Neerav Goyal ◽  
Bharat B. Yarlagadda ◽  
Daniel G. Deschler ◽  
Kevin S. Emerick ◽  
Derrick T. Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck ◽  
Free Flap ◽  
Operating Time ◽  
Surgical Site Infections ◽  
Free Flaps ◽  
Neck Surgery ◽  
Pedicled Flap ◽  
American Society ◽  
Clean Contaminated

Objective: To evaluate surgical site infections (SSI) after pedicled reconstruction in head and neck surgery. Methods: Records of patients with pedicled flap reconstructions between 2009 and 2014 at Massachusetts Eye and Ear were reviewed. Onset of SSI or fistula ≤30 days postoperatively was noted. A free flap cohort was reviewed for comparison. Results: Two hundred and eight pedicled reconstructions were performed for cancer (83%), osteoradionecrosis (7%), and other reasons (10%). Most (72%) cases were clean-contaminated and American Society of Anesthesiologists classification 3 or higher (73%); 63% of patients had prior radiation. The SSIs occurred in 9.1% and were associated with a longer length of stay ( P = .004) but no particular risk factors. Seventeen patients developed a fistula (11 without SSI). The SSI rates were not significantly different between pedicled and free flaps, but pedicled flap patients were older, more likely to have had prior surgery and/or radiation, and be methicillin-resistant Staphylococcus aureus positive. In the combined population, multivariate analysis demonstrated clean-contaminated wound classification ( P = .03), longer operating time ( P = .03), and clindamycin prophylaxis ( P = .009) as SSI risk factors. Conclusions: The SSI rate following pedicled flap surgeries was low and similar to free flap surgeries despite a significantly different population. No specific risk factors were associated with developing a pedicled flap SSI.

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