Upper-airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis
| Autor: | Patricia L. Hibberd, Mercedes Concepcion, Stephen J. Lipson, Ian Wattenmaker |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Arthritis Rheumatoid Myelopathy Internal medicine Intubation Intratracheal medicine Fiber Optic Technology Humans Intubation Orthopedics and Sports Medicine Aged Retrospective Studies Chi-Square Distribution business.industry Nerve Compression Syndromes General Medicine Perioperative Middle Aged Airway obstruction medicine.disease Rheumatology Surgery Airway Obstruction Bronchoscopes Logistic Models Spinal Fusion Anesthesia Orthopedic surgery Cervical Vertebrae Female Spinal Diseases business Airway Complication |
| Zdroj: | The Journal of Bone & Joint Surgery. 76:360-365 |
| ISSN: | 0021-9355 |
| DOI: | 10.2106/00004623-199403000-00006 |
| Popis: | We reviewed the records of 128 patients who had a total of 128 consecutive posterior operations on the cervical spine for problems related to rheumatoid arthritis. Our purpose was to examine perioperative complications related to the airway. The patients were divided into two groups for analysis on the basis of the technique of intubation that had been used. An upper-airway obstruction developed after extubation in eight (14 per cent) of the fifty-eight patients who had been intubated without fiberoptic assistance compared with one (1 per cent) of the seventy patients who had been intubated fiberoptically (p = 0.02). The two groups had similar characteristics with regard to age, sex, severity of the myelopathy, American Rheumatology Association classification, American Society of Anesthesiologists physical status classification, cigarette use, duration of the arthritis, use of preoperative traction, use of steroids (both preoperatively and intraoperatively), size of the endotracheal tube, duration of the operation, total duration of the anesthesia, intraoperative fluid balance, and type of immediate immobilization of the neck. The only significant difference between the groups was the time to extubation, which averaged 17.9 hours in the fiberoptic group and 10.6 hours in the non-fiberoptic group (p = 0.02). Logistic regression analysis showed that non-fiberoptic intubation was the significant risk factor, even when allowance was made for the difference in the lengths of time to extubation. We concluded that this life-threatening complication can be minimized with fiberoptic management of the airway. |
| Databáze: | OpenAIRE |
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