Sheshadri Veena, Moga Rebecca, Manninen Pirjo, Goldstein Christina L, Rampersaud Yoga Raja, Massicotte Eric M, Fehlings Michael G, Venkatraghavan Lashmi
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Canada.
Department of Orthopedic Surgery, Columbia, Missouri, United States.
J Clin Neurosci. 2017 May;39:124-129. doi: 10.1016/j.jocn.2016.12.036. Epub 2017 Jan 16.
Management of the airway may be challenging in patients undergoing occipito-cervical spine fusions (OCF). Changes in the occipito-cervical angle (dOC2A) of fusion after surgery may result in acute airway obstruction, dyspnea and/or dysphagia. Objectives of the study were to review the airway management of patients during posterior OCF, determine the incidence, nature and risk factors for postoperative airway adverse events (AEs), and to determine the relationship between airway AEs and the change in dOC2A. In this retrospective cohort of 59 patients, following extubation in the operating room (OR), there were no complications in 43 (73%) patients (Group 1). Sixteen (27%) patients (Group 2) had airway complications; 4 requiring reintubation and 12 having delayed extubation. The number of vertebral levels fused (>6), presence of difficult intubation and duration of surgery (>5h) were significantly associated with AEs. There was no significant difference in the dOC2A between the groups (-1.070±5.527 versus -4.375±10.788, p=0.127). Airway management in patients undergoing OCF poses a challenge for the anesthesiology and surgical teams. The incidence of AEs was 27%. The decision to extubate immediately after surgery needs to be individualized. Factors such as difficult intubation, number of vertebral levels fused and duration of surgery have to be considered. A significant correlation between dOC2A and postoperative AEs could not be established. Risk factors for postoperative AEs are multifactorial and prospective evaluation of these factors is indicated.
对于接受枕颈融合术（OCF）的患者，气道管理可能具有挑战性。手术后融合的枕颈角（dOC2A）变化可能导致急性气道梗阻、呼吸困难和/或吞咽困难。本研究的目的是回顾后路OCF患者的气道管理情况，确定术后气道不良事件（AE）的发生率、性质和危险因素，并确定气道AE与dOC2A变化之间的关系。在这个包含59例患者的回顾性队列研究中，在手术室（OR）拔管后，43例（73%）患者（第1组）没有并发症。16例（27%）患者（第2组）出现气道并发症；4例需要重新插管，12例延迟拔管。融合的椎体节段数（>6个）、困难插管的存在以及手术时间（>5小时）与AE显著相关。两组之间的dOC2A没有显著差异（-1.070±5.527对-4.375±10.788，p=0.127）。OCF患者的气道管理对麻醉和手术团队构成了挑战。AE的发生率为27%。术后立即拔管的决定需要个体化。必须考虑诸如困难插管、融合的椎体节段数和手术时间等因素。无法确定dOC2A与术后AE之间存在显著相关性。术后AE的危险因素是多因素的，需要对这些因素进行前瞻性评估。
