The Difficult Airway after Endoscopic Endonasal Skull Base Surgery: A Case Series and Management Algorithm
| Autor: | Carl H. Snyderman, Dennis P. Phillips, Joseph M. Darby, Courtney Chou |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Endoscopic endonasal surgery medicine.medical_treatment Risk Assessment Skull Base Neoplasms Cohort Studies 03 medical and health sciences Postoperative Complications Sex Factors 0302 clinical medicine 030202 anesthesiology medicine Humans Registries Airway Management Difficult airway Aged Retrospective Studies business.industry Age Factors Endoscopy Middle Aged Prognosis Management algorithm Surgery Airway Obstruction Skull Treatment Outcome medicine.anatomical_structure Otorhinolaryngology Skull base surgery Female Airway management business Algorithms 030217 neurology & neurosurgery |
| Zdroj: | Otolaryngology–Head and Neck Surgery. 159:927-932 |
| ISSN: | 1097-6817 0194-5998 |
| Popis: | To analyze difficult airway situations affecting patients after endoscopic endonasal surgery (EES) for skull base tumors and to develop an airway management algorithm.Case series with chart review.Single tertiary care center.Eleven difficult airway events occurred among patients after EES for skull base tumors, as identified through a retrospective review of our institutional Difficult Airway Management Team registry from January 2008 to March 2016. Data from these events included patient demographics, event characteristics, airway management techniques, and outcomes. Results were used to design a difficult airway protocol.The majority of patients were obese (63.6%) and had a dural defect (90.9%), each of which was repaired with a vascularized flap. The most common reasons for the difficult airway call were concern for using mask ventilation in a patient with a dural defect (27.3%) and difficult airway anatomy (27.3%). Two patients did not require airway intervention; 8 were intubated; and 1 underwent cricothyroidotomy. Videolaryngoscopy was the most common first-attempt intubation technique, followed by conventional direct laryngoscopy. Effective adjunctive techniques included intubation through a laryngeal mask airway and bougie-guided intubation. As compared with simple mask ventilation, laryngeal mask airway-assisted ventilation was associated with a decreased incidence of postevent cerebrospinal fluid leak. There were no incidences of postevent pneumocephalus, cardiopulmonary arrest, or mortality.We propose a difficult airway algorithm for patients following EES of the skull base, with sequential recommendations for airway management methods and commentary on adjunctive techniques. |
| Databáze: | OpenAIRE |
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