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Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy.
Debkowska, Monika P; Butterworth, John F; Moore, Jaime E; Kang, Soobin; Appelbaum, Eric N; Zuelzer, Wilhelm A.
Afiliação
  • Debkowska MP; Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
  • Butterworth JF; Department of Anesthesiology, Virginia Commonwealth University Health, Richmond, VA, USA.
  • Moore JE; Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
  • Kang S; Department of Radiology, Virginia Commonwealth University Health, Richmond, VA, USA.
  • Appelbaum EN; Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
  • Zuelzer WA; Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
J Spine Surg ; 5(1): 142-154, 2019 Mar.
Article em En | MEDLINE | ID: mdl-31032449
Anterior cervical spine surgery (ACSS) is a common procedure, but not without its own risks and complications. Complications that can cause airway compromise occur infrequently, but can rapidly lead to respiratory arrest, leading to severe morbidity or death. Knowing emergent post-operative airway management including surgical airway placement is critical. We aim to review the different etiologies of post-operative airway compromise following ACSS, the predictable timeline in which they occur, and the most appropriate treatment and management for each. We place special emphasis on the timing and proper surgical technique for an emergent cricothyrotomy. Angioedema is seen the earliest as a cause of post-operative airway compromise, typically within 6-12 hours. Retropharyngeal hematomas can be seen between 6-24 hours, most commonly within 12 hours. Pharyngolaryngeal edema is seen within 24-72 hours. After 72 hours, retropharyngeal abscess is the most likely etiology. Several studies have utilized delayed extubation protocols following ACSS based on patient risk factors and found reduced postoperative airway complications and reintubation rates. The administration of perioperative corticosteroids continues to be controversial with high-level studies recommending both for and against their use. Animal studies showed that after cardiac arrest, the brain can recover if oxygenation is restored within 5 minutes, but this time is likely shorter with asphyxia prior to cardiac arrest. Experience and training are essential to reduce the time for successful cricothyrotomy placement. Physicians must be prepared to diagnose and treat acute postoperative airway complications following ACSS to prevent anoxic brain injury or death. If emergent intubation cannot be accomplished on the first attempt, physicians should not delay placement of a surgical airway such as cricothyrotomy.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2019 Tipo de documento: Article