ABSTRACT
PURPOSE: Sleep-disordered breathing (SDB) may be a critical risk factor for emergence agitation (EA). We hypothesized that SDB diagnosis is a predictor of EA in children after general anesthesia for ambulatory surgery. DESIGN: Prospective, observational, cohort study. METHODS: Children aged 4 to 17 years were assessed for the occurrence of EA. Differences in probability of EA were assessed using multivariable logistic regression analyses. FINDINGS: Of 1,076 children, 66 (6.1%) had EA. Compared with those without EA, children with EA were younger (P < .001), more likely to have had mask induction (P < .001) and a preoperative diagnosis of SDB (P = .008). On multivariable analysis, SDB, severe obesity, decreasing age in years, increasing first arousal pain score, and intraoperative use of sevoflurane were independently associated with EA. CONCLUSIONS: SDB and severe obesity may be critical independent predictors of EA in children. Mechanisms underlying these observations deserve further elucidation.
Subject(s)
Ambulatory Surgical Procedures/adverse effects , Obesity/complications , Psychomotor Agitation/etiology , Respiration , Sleep Wake Disorders/complications , Adolescent , Child , Female , Humans , Male , Obesity/physiopathology , Obesity/psychology , Risk Factors , Sleep Wake Disorders/physiopathology , Sleep Wake Disorders/psychologyABSTRACT
Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
Subject(s)
Airway Obstruction/etiology , Blood Vessel Prosthesis/adverse effects , Carotid Artery Diseases/complications , Carotid Artery Diseases/therapy , Carotid Artery Injuries/complications , Carotid Artery Injuries/therapy , Embolization, Therapeutic/adverse effects , Airway Obstruction/diagnostic imaging , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Injuries/diagnostic imaging , Carotid Artery, External , Embolization, Therapeutic/methods , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Humans , Middle Aged , Tomography, X-Ray Computed , Tongue Neoplasms/complications , Tongue Neoplasms/diagnostic imaging , Tongue Neoplasms/surgery , Treatment OutcomeABSTRACT
Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.
