Department of Plastic and Reconstructive Surgery, The Spires Cleft Centre, Children's Hospital, Oxford University Hospital NHS Trust, Oxford, UK.
Department of Anaesthesia, Salisbury NHS Trust, Salisbury, UK.
Cleft Palate Craniofac J. 2022 Feb;59(2):185-191. doi: 10.1177/10556656211000553. Epub 2021 Apr 1.
The use of throat packs during oropharyngeal surgery has long been a topic of debate among cleft surgeons. The advantage of inserting an absorbent tulle within the pharynx must be weighed against the risk of unintended retention postoperatively. Despite safety check mechanisms in place, retention may occur with potentially life-threatening consequences. We present a comprehensive review of throat pack use in all cleft units within the United Kingdom and Ireland.
All 20 cleft surgery units in the United Kingdom and Ireland were surveyed on their use of throat packs in children aged 6 months to 2 years undergoing elective cleft palate surgery.
The response rate to the survey was 100%. Seventy-five percent of units currently use throat packs; in 40%, they are used in addition to cuffed endotracheal tubes (ETTs). Inclusion of the throat pack in the surgical swab count was perceived as the safest mechanism employed to avoid retention. 26.1% of respondents were aware of at least 1 incident of pack retention in their unit.
DISCUSSION/CONCLUSION: The reported UK and Irish experience demonstrates that three-quarters of units routinely use packs. Notably, a quarter of respondents to the survey have experience of an incident of throat pack retention. Nevertheless, the majority of respondents considered the perceived risk of retaining a pack to be low. The growing use of microcuffed ETTs in UK cleft units paired with a low incidence of perioperative complications when a throat pack is not introduced might prompt cleft surgeons to review routine pharyngeal packing.
在口咽手术中使用咽喉填塞物一直是腭裂外科医生争论的话题。在权衡将吸收性明胶海绵置于咽中的优势与术后意外滞留的风险时，必须考虑这一点。尽管有安全检查机制，但仍可能发生潜在的危及生命的后果。我们对英国和爱尔兰所有腭裂单位使用咽喉填塞物的情况进行了全面回顾。
对英国和爱尔兰的 20 个腭裂手术单位进行了调查，调查对象为接受择期腭裂手术的 6 个月至 2 岁儿童。
对该调查的回复率为 100%。目前，75%的单位使用咽喉填塞物；在 40%的单位中，它们与带套囊的气管内导管（ETT）一起使用。将咽喉填塞物纳入手术拭子计数被认为是避免滞留的最安全机制。26.1%的受访者在其单位中至少有 1 例填塞物滞留的事件。
讨论/结论：英国和爱尔兰的经验表明，四分之三的单位常规使用填塞物。值得注意的是，四分之一的受访者在调查中经历过咽喉填塞物滞留的事件。尽管如此，大多数受访者认为保留填塞物的风险较低。英国腭裂单位中微套囊 ETT 的使用越来越多，且在不引入咽喉填塞物的情况下，围手术期并发症的发生率较低，这可能促使腭裂外科医生重新评估常规咽部填塞。
