CT manifestations and application progress of airway complications after lung transplantation / 器官移植

With the continuous improvement of surgical techniques and perioperative management, the success rate of lung transplantation has gradually increased, but airway complications after lung transplantation are still common. Airway complications after lung transplantation may reduce the quality of life, increase medical costs, and even threaten the lives of the recipients. In 2018, the International Society for Heart and Lung Transplantation (ISHLT) consensus proposed that airway complications included ischemic necrosis, anastomotic dehiscence, airway stenosis and tracheobronchomalacia. Bronchoscopy remains the gold standard for the diagnosis of airway complications. However, during the follow-up of lung transplant recipients, use of end-inspiratory CT scan combined with end-expiratory or dynamic expiratory CT scan may contribute to identifying a variety of airway complications, evaluating the location and degree of airway complications and providing beneficial supplement for the selection of clinical treatment.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery / O efeito da exposição passiva à fumaça de tabaco em complicações respiratórias no perioperatório e a duração da recuperação

Abstract Background: The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Methods: Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. Results: A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Conclusion: Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Resumo Justificativa: A incidência de complicações respiratórias no perioperatório e o tempo em sala de recuperação pós-anestesia no pós-operatório em pacientes com exposição passiva à fumaça de tabaco foram avaliados de acordo com o grau de exposição. Métodos: Foram avaliados 270 pacientes entre 18-60 anos, estado físico ASA I ou II, passivamente expostos e não expostos à fumaça de tabaco, submetidos à anestesia geral para vários procedimentos cirúrgicos eletivos. Os pacientes foram divididos em dois grupos: passivamente expostos e não expostos à fumaça de tabaco. Aqueles com exposição passiva à fumaça também foram divididos em dois grupos de acordo com o grau de exposição. Os pacientes enviados à sala de recuperação pós-anestesia (SRPA) no fim da cirurgia foram monitorados até atingir 9 ou mais no escore modificado de Aldrete. As complicações respiratórias foram avaliadas e registradas nos períodos intraoperatório e pós-operatório. Resultados: Foram incluídos 251 pacientes, dos quais 63 (25,1%) apresentaram complicações respiratórias, 11 (4,4%) complicações no intraoperatório e 52 (20,7%) complicações no pós-operatório. Houve relação significativa entre a exposição passiva à fumaça de tabaco e a alta incidência de complicações respiratórias no perioperatório e pós-operatório. O risco de complicação como tosse, dessaturação e hipersecreção aumentou de acordo com o grau de exposição. Houve relação significativa entre o grau de exposição passiva à fumaça e o tempo de permanência em SRPA. Conclusão: Os pacientes com exposição passiva à fumaça de tabaco apresentaram altas taxas de complicações respiratórias no perioperatório e prolongamento da permanência em SRPA, em comparação com os pacientes não expostos.

Factors contributing to delayed extubation after cervical spine surgery in Siriraj Hospital.

Background: Cervical spine surgery brings up great concerns about post operative severe complications and morbidities. Anesthesiologists should know contributing factors for the delayed extubation which includes patient factors, surgical factors, and anesthetic factors. Objective: To study the factors related to delayed extubation for the benefit of anesthetists’ future decision making and the patients’ safety. Methods: Case-controlled study in a retrospective fashion. Patients who undertook cervical spine surgery during 2002 - 2007 without previous intubation, tracheostomy, and ones with data available to be collected; were identified for the study. Data included age, sex, BMI, ASA classification, smoking history, pre-operative neurological deficit, history of previous C-spine surgery, steroid administration, number of cervical spine surgeries, upper cervical level including, surgical approach, instruments, intubation technique, duration of the operation, total blood loss, and total fluid replacement. All 16 factors were studied and analyzed for their relationship to extubation difficulty. Results: Of all 140 patients identified in the study, 70 were patients with immediate extubation and 70 were patients with delayed extubation. Factors that are statistically significant in delayed extubation are: advancing age >60 years, ASA classification > class 2, preoperative neurological deficit, surgery >2 levels of spines, duration of the operation >180 minutes, fiberoptic intubation technique, total fluid administration >4,000 ml during surgery and total blood loss >250 ml. When analyzed with multivariate analysis, factors that related to delayed extubation are advancing age >60 years (odds ratio 4.077, 95% CI 1.562-10.641), neurological deficit (odds ratio 5.719, 95% CI 1.312-24.927), surgery >2 levels of spines (odds ratio 4.108, 95% CI 1.672-10.095), duration of operation >180 minutes (odds ratio 4.538, 95% CI 1.687-12.205), and fiberoptic intubation technique (odds ratio 4.131, 95% CI 1.636-10.433). Conclusion: There are 5 contributively factors that are related to delayed extubation in patients receiving cervical spine surgery at Siriraj Hospital: advancing age > 60 years, neurological deficit, surgery >2 levels of cervical spines, duration of the operation >180 minutes, and fiberoptic intubation technique.

Diagnosis and Treatment of Airway Complication After Heart-lung Transplantation / 中国医师杂志

Objective To sum up the diagnosis and treatment of airway complication after heart-lung transplantation. Methods One patient who occurred dyspnea, cough and wheeze at the 200th day after heart-lung transplantation, was diagnosed suffering from anastomosis stenosis. Comprehensive multimodality approach such as rigid bronchoscopic debridement and laser photoresection were performed. Eventually, this case was surgically managed with sleeve resection of stenotic bronchial segment. Results Surgical operation by sleeve resection of stenotic segment was successful, and the patient's symptoms disappeared. Till now the patient has been living more than 14 months after transplant, and CT scanning and fibrous bronchoscopy examination showed that the anastomasis healed well. Conclusion Airway complication's early recognition and proper management could improve the patients symptoms and survival rate.