Schwer Christian I, Roth Teresa, Gass Mathieu, Rothweiler René, Loop Torsten, Metzger Marc C, Kalbhenn Johannes
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany.
Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, 79106 Freiburg, Germany.
J Clin Med. 2022 Jul 1;11(13):3829. doi: 10.3390/jcm11133829.
Bimaxillary orthognathic surgery bears the risk of severe postoperative airway complications. There are no clear recommendations for immediate postoperative follow-up and monitoring.
to identify potential risk factors for prolonged mechanical ventilation and delayed extubation in patients undergoing bimaxillary orthognathic surgery.
The data of all consecutive patients undergoing bimaxillary surgery between May 2012 and October 2019 were analyzed in a single-center retrospective cohort study. The clinical data were evaluated regarding baseline characteristics and potential factors linked with delayed extubation.
A total of 195 patients were included; 54.9% were female, and the median age was 23 years (IQR 5). The median body mass index was 23.1 (IQR 8). Nine patients (4.6%) were of American Society of Anesthesiologists Physical Status Classification System III or higher. The median duration of mechanical ventilation in the intensive care unit was 280 min (IQR, 526 min). Multivariable analysis revealed that premedication with benzodiazepines (odds ratio (OR) 2.60, 95% confidence interval (0.99; 6.81)), the male sex (OR 2.43, 95% confidence interval (1.10; 5.36)), and the duration of surgery (OR 1.54, 95% confidence interval (1.07; 2.23)) were associated with prolonged mechanical ventilation. By contrast, total intravenous anesthesia was associated with shorter ventilation time (OR 0.19, 95% confidence interval (0.09; 0.43)).
premedication with benzodiazepines, the male sex, and the duration of surgery might be considered to be independent risk factors for delayed extubation in patients undergoing bimaxillary surgery.
双颌正颌手术存在严重术后气道并发症的风险。目前对于术后即刻的随访和监测尚无明确建议。
确定双颌正颌手术患者机械通气时间延长和拔管延迟的潜在危险因素。
在一项单中心回顾性队列研究中，分析了2012年5月至2019年10月期间所有连续接受双颌手术患者的数据。对临床数据进行评估，分析基线特征以及与拔管延迟相关的潜在因素。
共纳入195例患者；54.9%为女性，中位年龄为23岁（四分位间距为5）。中位体重指数为23.1（四分位间距为8）。9例患者（4.6%）属于美国麻醉医师协会身体状况分级系统III级或更高。重症监护病房机械通气的中位时长为280分钟（四分位间距为526分钟）。多变量分析显示苯二氮䓬类药物术前用药（比值比（OR）2.60，95%置信区间（0.99；6.81））、男性（OR 2.43，95%置信区间（1.10；5.36））以及手术时长（OR 1.54，95%置信区间（1.07；2.23））与机械通气时间延长相关。相比之下，全静脉麻醉与较短的通气时间相关（OR 0.19，95%置信区间（0.09；0.43））。
苯二氮䓬类药物术前用药、男性以及手术时长可能被视为双颌手术患者拔管延迟的独立危险因素。
