학술논문
A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure.
Document Type
Academic Journal
Author
Cuperus, Iris E.; Mathijssen, Irene M.J.; van Veelen, Marie-Lise C.; Bouzariouh, Anouar; Stubelius, Ingrid; Kölby, Lars; Lundborg, Christopher; Das, Sumit; Johnson, David; Wall, Steven A.; Larysz, Dawid F.; Dowgierd, Krzysztof; Koszowska, Małgorzata; Schulz, Matthias; Gratopp, Alexander; Thomale, Ulrich-Wilhelm; Zafra Vallejo, Víctor; Redondo Alamillos, Marta; Ferreras Vega, Rubén; Apolito, Michela; Vergnaud, Estelle; Paternoster, Giovanna; Khonsari, Roman H.
Source
Plastic and Reconstructive Surgery. Jan 30, 2024
Subject
Language
English
ISSN
0032-1052
Abstract
BACKGROUND:: Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. METHODS:: A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures. RESULTS:: Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 – 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. CONCLUSIONS:: Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.