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@#Free tissue flap transplantation is the preferred option for repairing and reconstructing postoperative defects in oral and maxillofacial-head malignant tumors. However, challenges remain for oral and maxillofacial-head and neck oncology surgeons in terms of ischemia-reperfusion (I/R) injury, airway management, quality of life and prognosis. I/R injury is an inevitable complication of free-flap transplantation surgery. In addition to shortening the vascular anastomosis time as much as possible during the surgical process, many studies have attempted to further prevent and treat free-flap I/R injury using physical intervention therapy, antioxidant and reactive oxygen species (ROS) scavenger therapy, hyperbaric oxygen therapy, etc. However, there is a lack of large-scale clinical randomized controlled trial evidence to further support these methods. Postoperative tracheal management of patients receiving free tissue flap transplantation is very important. In recent years, delayed extubation has been proposed as an alternative to traditional tracheostomy. This method can facilitate wound care for patients, reduce infections, speed up patient recovery, and reduce the incidence of vascular crises. In the future, such management is expected to improve the practicality and safety of delayed extubation by formulating more appropriate patient selection criteria and intensive care plans. Preoperative selection of suitable free tissue flaps according to the defect for repair and reconstruction is beneficial for improving the quality of life and survival rate of patients. At the same time, for patients who require postoperative radiotherapy, reducing the complications of postoperative radiotherapy and improving the quality of life of patients can be achieved through intraoperative nerve anastomosis, preradiation oral hygiene maintenance, early speech training, and other methods.
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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.
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0.05) in the two periods,the ratio of tracheostomy was significantly higher (P
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In most cases, extubation may be safely performed in the operating rooms. However, some cases need leaving the endotracheal tube in place until the patient's condition is appropriate, usually in the Postaneshesia Care Unit (PACU) or Intensive Care Unit (ICU). We retrospectively reviewed the recovery room record of 4,241 patients who performed on operation under general anesthesia at Inha Hospital from January 1993 to December 1993, and then examined into details how many factors are influenced to the time of extubation following surgery. The results were as follows; 1) The overaU frequency of delayed extubation (or PACU extubation) was 9.8% (423/4,241). 2) The surgical disciplines which had the highest number and incidence of delayed extubations were the general surgery (172 cases) and dental surgery (25%), respectively. 3) According to sex, the male patients (243) outnumbered the female counterparts (180). 4) According to age, delayed extubation was most common among infants (<1 year of age) (21.4%). 5) According to operation site, delayed extubation occurred most commonly among operations involving upper abdominal regian (36.1%) followed by thoracic region (22.9%). In conclusion, extubation should be performed when the patient is nearly fuUy awake, of acceptable respiratory rate and depth, and when the effects of muscle relaxants have been fully reversed.