Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Korean Med Sci. 2018 Jan 30;33(17):e77. doi: 10.3346/jkms.2018.33.e77. eCollection 2018 Apr 23.
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.
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.
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 ( = 0.015), diabetes mellitus ( = 0.003), operative time longer than 5 hours ( = 0.048), and estimated blood loss (EBL) greater than 300 mL ( = 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation.
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.
对于行前路颈椎手术（ACSS）的患者，术后气道管理标准化至关重要。由于缺乏评估 ACSS 后这些气道并发症的临床系列研究，导致在统计学分析方面存在重大局限性。
对术后发生气道窘迫（插管超过 24 小时或术后 7 天内计划外再次插管）的患者进行回顾性队列研究。如果术后出现明显的椎前软组织肿胀，患者将接受长时间插管（超过 24 小时）。分析了术前和术中患者数据以及术后结果（拔管和再次插管时间）。
2008 年至 2016 年，共进行了 400 例 ACSS。其中 389 例（97.25%）患者术后 24 小时内拔管，无气道并发症，但 11 例（2.75%）患者出现术后气道阻塞；7 例（1.75%）需要长时间插管，4 例（1.00%）需要计划外再次插管。拔管时间分别为 2.75 小时（范围：0-23 小时）和 50.55 小时（范围：0-250 小时）。年龄（=0.015）、糖尿病（=0.003）、手术时间长于 5 小时（=0.048）和估计出血量（EBL）大于 300 mL（=0.042）与长时间插管或再次插管有关。在长时间插管组中，所有患者拔管后均无气道窘迫。
在 ACSS 中，术后气道阻塞与患者和手术因素有关。我们建议对有这些危险因素的患者进行长时间插管，以实现安全有效的拔管。
