Analysis of the Risk Factors Associated with Prolonged Intubation or Reintubation after Anterior Cervical Spine Surgery

BACKGROUND: Standardized postoperative airway management is essential for patients undergoing anterior cervical spine surgery (ACSS). The paucity of clinical series evaluating these airway complications after ACSS has been resulted in a significant limitation in statistical analyses. METHODS: A retrospective cohort study was performed regarding airway distress (intubation for more than 24 hours or unplanned reintubation within 7 days of operation) developed after ACSS. If prevertebral soft tissue swelling was evident after the operation, patients were managed with prolonged intubation (longer than 24 hours). Preoperative and intraoperative patient data, and postoperative outcome (time to extubation and reintubation) were analyzed. RESULTS: Between 2008 and 2016, a total of 400 ACSS were performed. Of them, 389 patients (97.25%) extubated within 24 hours of surgery without airway complication, but 11 patients (2.75%) showed postoperative airway compromise; 7 patients (1.75%) needed prolonged intubation, while 4 patients (1.00%) required unplanned reintubation. The mean time for extubation were 2.75 hours (range: 0–23 hours) and 50.55 hours (range: 0–250 hours), respectively. Age (P = 0.015), diabetes mellitus (P = 0.003), operative time longer than 5 hours (P = 0.048), and estimated blood loss (EBL) greater than 300 mL (P = 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation. CONCLUSION: In ACSS, postoperative airway compromise is related to both patients and operative factors. We recommend a prolonged intubation for patients who are exposed to these risk factors to perform a safe and effective extubation.

Acute Myocardial Infarction and Postpharyngeal Hematoma after Anterior Cervical Spine Surgery on a Coronary Artery Disease Patient: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of preventive intubation to coronary artery disease patient who underwent percutaneous coronary intervention following an anterior cervical spine surgery. SUMMARY OF LITERATURE REVIEW: Postpharyngeal hematoma occurs more to a patient who underwent percutaneous coronary intervention for myocardial infarction following an anterior cervical spine surgery. And postoperative airway obstruction due to it is one of the most serious adverse events associated with anterior cervical spine surgery. Preventive intubation was tried and it was useful for treatment. MATERIALS AND METHODS: A 61-year-old man suffered from neck pain and radiating pain on left upper extremity was performed an anterior cervical spine surgery. After operation, he complained acute myocardial infarction symptoms and Emergency percutaneous coronary intervention was performed. After that, postpharyngeal hematoma appeared and compressed the airway. Intubation was performed to prevent airway obstruction. RESULT: Airway obstruction was prevented through early intubation. Hematoma evacuation and insertion of Hemovac performed and the patient discharged without any complications such as neurologic or cardiac problems. CONCLUSION: Preventive intubation to coronary artery disease patient who underwent percutaneous coronary intervention following an anterior cervical spine surgery is useful for treatment of airway obstruction due to postpharyngeal hematoma.

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases

BACKGROUND: Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease. METHODS: We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation. RESULTS: There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01). CONCLUSIONS: To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Postoperative Tracheal Mucosa Ischemia by Endotracheal Tube Cuff Pressure Change During the Anterior Cervical Spine Surgery

OBJECTIVE: Endotracheal tube cuff-pressure(ETCP) increases significantly during anterior cervical spine surgery with neck retraction. Clinically, postoperative hoarseness with sore throat is correlated with vocal cord edema due to longer intubation time and higher ETCP during neck retraction. METHODS: Fifty patients of anterior cervical spine surgery were randomized to a control (no adjustment, 25 cases) and a treatment group (ETCP adjusted to 20mmHg, 25 cases). Patients were blinded to their group assignments. They were questioned about the presence of ischemic symptoms (sore throat, dysphagia, hoarseness) postoperatively at different time points; 4 hours, 24 hours, and 1 week postoperatively. RESULTS: No differences between groups at 4 hours and 1 week postoperatively were demonstrated. At 24 hours, 36% of patients in the treatment group complained of sore throat while 56% of control group patients did (p<0.05). Female patients correlated with development of all ischemic discomfort (p<0.05: sore throat, hoarseness, dysphagia). CONCLUSION: Our results suggest that postoperative ischemic symptom following anterior cervical spine surgery may be associated with the two predictors; increased ETCP during neck retraction and female. The simple procedure of maintaining ETCP to 20mmHg can prevent postoperative tracheal ischemic symptom.

Clinical Efficacy of Two Kinds of Regimes in the Treatment of Airway Obstruction in Patients Undergoing Anterior Cervical Spine Surgery / 中国药房

OBJECTIVE:To probe into effect of aerosol inhalation of ambroxol hydrochloride on phlegm-removing and airway obstruction in patients undergoing anterior cervical spine surgery. METHODS:62 patients undergoing anterior cervical spine surgery were treated with primary treatment. Treatment group were additionally given 30 mg ambroxol hydrochloride added into aerosol inhalation and control group were treated with 4 000 IU ?-chymotrypsin added into aerosol inhalation. Both groups were treated wreistpho innshea lraattieo nw oefr e6 ～978% L ?fomr intr-e1a tomxyengte ng-roduripv eann dae 7ro1s%ol s ftowr icceo nat rdoal yg reoaucph (timP

Paradoxical Upper Airway Obstruction and Central Sleep Apnea Developed After Anterior Cervical Spine Fusion / 결핵및호흡기질환

We report a case of a 48-year-old man with a paradoxic upper airway obstruction and central sleep apnea that developed after an anterior cervical spinal fusion. Nine months before being admitted to this hospital, he was diagnosed with a herniated intervertebral disc between the 5th and 6th cervical spine, and the first operation was carried out. Two months later, a pseudoarthrosis has developed and a second operation, an anterior interbody fusion of the C5 and C6 using autogenous strut bone graft, was performed. After the second operation, he began to complain of snoring, excessive daytime sleepiness, insomnia, and a bizarre sound heard near the upper airway during breathing. Nasopharyngoscope and magnetic resonance imaging disclosed a paradoxical narrowing of the nasopharynx during expiration. On the overnight polysomnography, the apnea index was 8.7/h (central apnea, 7.0/h; obstructive apnea, 1.7/h). Nasal continuous positive airway pressure was applied, but he complained of pressure-intolerance, and laser-assisted uvulopalatoplasty was then performed. Two months after surgery, clinical symptoms as well as the apneas had improved markedly. We suggest that this paradoxic upper airway obstruction might be associated with the anterior cervical spinal surgery even though the mechanism is unclear. This case also emphasizes that an upper airway obstruction can contribute to the development of central sleep apnea.

Vertebral Artery Injury during Anterior Cervical Spine Surgery: Report of Two Cases

Vertebral artery injury is a rare complication of anterior cervical approach. We report two patients who suffered injury to vertebral artery during anterior cervical spine surgery. The mechanism of injury, their operative management, and the subsequent outcome were assessed and relevant literatures reviewed. The awareness of the possibility of vertebral artery injury is most important to prevent and it's occurrence is best avoided by a thorough understanding of the anatomical relationships of the artery, the spinal canal, and the vertebral body and careful use of surgical instruments.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report

The authors experienced 4 cases of esophageal perforations following anterior cervical spine surgery. All occurred within a few days in the postoperative period. Diagonosis was made by clinical suspision and confirmed by esophography or reexploration. This complication attributed to sharp blade penetration of a retraction during surgery, infection and use of hardware. 3 cases were successfully treated by drainage, tube feeding and parenteral antibiotics. But unfortunately, 1 case was fatality. Although conservative treatment is required prolonged hospitalization, drainage, tube feeding and parenteral antibiotics are recommended treatment.

Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report

The authors experienced 4 cases of esophageal perforations following anterior cervical spine surgery. All occurred within a few days in the postoperative period. Diagonosis was made by clinical suspision and confirmed by esophography or reexploration. This complication attributed to sharp blade penetration of a retraction during surgery, infection and use of hardware. 3 cases were successfully treated by drainage, tube feeding and parenteral antibiotics. But unfortunately, 1 case was fatality. Although conservative treatment is required prolonged hospitalization, drainage, tube feeding and parenteral antibiotics are recommended treatment.