Powers Matthew A, Mudd Pamela, Gralla Jane, McNair Bryan, Kelley Peggy E
University of Colorado School of Medicine, Department of Otolaryngology & Children's Hospital Colorado, 13120 E. 19th Avenue, Mail Stop C292, Aurora, CO 80045, United States.
Int J Pediatr Otorhinolaryngol. 2013 Sep;77(9):1567-74. doi: 10.1016/j.ijporl.2013.07.011. Epub 2013 Aug 9.
Examine outcomes of varied postoperative sedation management in pediatric patients recovering from single stage laryngotracheal reconstruction.
Retrospective review of 34 patients treated with single stage laryngotracheal reconstruction from 2001 through 2011.
Tertiary children's hospital.
Patients were divided into 2 groups: those managed postoperatively with sedation, with or without paralysis (group 1), and those managed awake with narcotic pain medication as needed for primary management (group 2). Outcomes were measured as a function of sedation management. Outcomes investigated focused on those related to the success of the airway reconstruction, and those related to sedation management.
Out of 68 cases of laryngotracheal reconstruction reviewed from 2001 to 2011, 34 were single stage reconstructions. Nineteen patients were sedated postoperatively (group 1) and fifteen patients were left awake (group 2). There were no significant differences between groups in airway-related outcomes, including risk of accidental decannulation, revision rates, and need for secondary airway procedures such as balloon dilation. Sedation-related outcomes, specifically focusing on differences in medical management, showed significant increases in rates of withdrawal (p<0.0001), nursing concerns of withdrawal (p<0.0001) and sedation level (p<0.0001), pulmonary complications (OR 7.7, p=0.008), and prolonged hospital stay due to withdrawal (p=0.0005) in patients managed with sedation with or without paralysis. Multivariable regression analysis revealed that duration of sedation was the primary risk factor for increased postoperative morbidity, while younger age, lower weight, and use of a posterior graft were also significant variables assessed.
Avoiding sedation as the standard for postoperative management of single stage laryngotracheal reconstruction airway patients leads to an overall decreased risk of morbidity without increasing risk of airway-specific morbidity. This is specifically as related to withdrawal, pulmonary complications, concerns about sedation level and prolonged hospital course, all of which increase significantly with increased level and duration of sedation.
研究接受一期喉气管重建术的儿科患者采用不同术后镇静管理方法的效果。
对2001年至2011年期间接受一期喉气管重建术的34例患者进行回顾性研究。
三级儿童医院。
患者分为两组：术后接受镇静治疗（伴或不伴肌松）的患者（第1组），以及根据需要使用麻醉性镇痛药进行清醒管理的患者（第2组）。根据镇静管理情况对结果进行评估。所研究的结果重点关注与气道重建成功相关的结果以及与镇静管理相关的结果。
在2001年至2011年期间回顾的68例喉气管重建病例中，34例为一期重建。19例患者术后接受镇静治疗（第1组），15例患者保持清醒（第2组）。两组在气道相关结果方面无显著差异，包括意外拔管风险、翻修率以及是否需要进行球囊扩张等二次气道手术。与镇静相关的结果，特别是关注医疗管理差异的结果显示，接受镇静治疗（伴或不伴肌松）的患者在撤药率（p<0.0001）、撤药的护理问题（p<0.0001）、镇静水平（p<0.0001）、肺部并发症（OR 7.7，p=0.008）以及因撤药导致的住院时间延长（p=0.0005）方面均有显著增加。多变量回归分析显示，镇静持续时间是术后发病率增加的主要危险因素，而年龄较小、体重较低以及使用后移植片也是评估的重要变量。
避免将镇静作为一期喉气管重建气道患者术后管理的标准可降低总体发病风险，且不增加气道特异性发病风险。这尤其与撤药、肺部并发症、对镇静水平的担忧以及住院时间延长有关，所有这些都会随着镇静水平和持续时间的增加而显著增加。
