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Dilger AE, Meiklejohn DA, Bent JP, Tummala N, Bergmark RW, Lalakea ML. Climate change and environmental sustainability in otolaryngology: A state-of-the-art review. Surgeon 2024:S1479-666X(24)00065-9. [PMID: 38972805 DOI: 10.1016/j.surge.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Climate change has been identified by the World Health Organization (WHO) as the greatest existing threat to human health. Given the direct exposure of the upper aerodigestive system to pollutants, patients in otolaryngology are at high risk for increased disease burden in the setting of climate change and worsening air quality. Given this and the environmental impact of surgical care, it is essential for surgeons to understand their role in addressing climate health through quality-driven clinical initiatives, education, advocacy, and research. METHODS A state-of-the-art review was performed of the existing literature on the otolaryngologic health impacts of climate change and environmental sustainability efforts in surgery with specific attention to studies in otolaryngology - head and neck surgery. FINDINGS Climate variables including heat and air pollution are associated with increased incidence of allergic rhinitis, chronic rhinosinusitis and head and neck cancer. A number of studies have shown that sustainability initiatives in otolaryngology are safe and provide direct cost benefit. CONCLUSION Surgeons have the opportunity to lead on climate health and sustainability to address the public health burden of climate change.
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Affiliation(s)
- Amanda E Dilger
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
| | - Duncan A Meiklejohn
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - John P Bent
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neelima Tummala
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Regan W Bergmark
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Otolaryngology - Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - M Lauren Lalakea
- Division of Otolaryngology - Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Ferreira PRC, De Oliveira RIP, Vaz MD, Bentes C, Costa H. Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction. J Clin Med 2023; 12:6445. [PMID: 37892584 PMCID: PMC10607324 DOI: 10.3390/jcm12206445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Head and neck free-flap microvascular surgeries are complex and resource-intensive procedures where proper conduct of anaesthesia plays a crucial role in the outcome. Flap failure and postoperative complications can be attributed to multiple factors, whether surgical- or anaesthesia-related. The anesthesiologist should ensure optimised physiological conditions to guarantee the survival of the flap and simultaneously decrease perioperative morbidity. Institutions employ different anaesthetic techniques and results vary across centres. In our institution, two different total intravenous approaches have been in use: a remifentanil-based approach and a multimodal opioid-sparing approach, which is further divided into an opioid-free anaesthesia (OFA) subgroup. We studied every consecutive case performed between 2015 and 2022, including 107 patients. Our results show a significant reduction in overall complications (53.3 vs. 78.9%, p = 0.012), length of stay in the intensive care unit (3.43 ± 5.51 vs. 5.16 ± 4.23 days, p = 0.046), duration of postoperative mechanical ventilation (67 ± 107 vs. 9 ± 38 h, p = 0.029), and the need for postoperative vasopressors (10% vs. 46.6%, p = 0.001) in the OFA group (vs. all other patients). The multimodal and OFA strategies have multiple differences regarding the fluid therapy, intraoperative type of vasopressor used, perioperative pathways, and various drug choices compared to the opioid-based technique. Due to the small number of cases in our study, we could not isolate any attitude, as an independent factor, from the success of the OFA strategy as a whole. Large randomised controlled trials are needed to improve knowledge and help define the ideal anaesthetic management of these patients.
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Affiliation(s)
- Paulo-Roberto Cardoso Ferreira
- Centro Hospitalar de Vila Nova de Gaia, 4434-502 Vila Nova de Gaia, Portugal
- Medical Sciences Department, University of Aveiro, 3810-193 Aveiro, Portugal
| | | | - Marta Dias Vaz
- Centro Hospitalar de Vila Nova de Gaia, 4434-502 Vila Nova de Gaia, Portugal
| | - Carla Bentes
- Centro Hospitalar de Vila Nova de Gaia, 4434-502 Vila Nova de Gaia, Portugal
| | - Horácio Costa
- Centro Hospitalar de Vila Nova de Gaia, 4434-502 Vila Nova de Gaia, Portugal
- Medical Sciences Department, University of Aveiro, 3810-193 Aveiro, Portugal
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Salama G, Motamed C, Elmawieh J, Suria S. Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040722. [PMID: 37109680 PMCID: PMC10142708 DOI: 10.3390/medicina59040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.
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Affiliation(s)
- Guillaume Salama
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Cyrus Motamed
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Jamie Elmawieh
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
| | - Stéphanie Suria
- Department of Anesthesia, Institut de Cancérologie Gustave Roussy, 94080 Villejuif, France
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Dilger AE, Bergmark RW. Environmental sustainability in otolaryngologic surgery. Curr Opin Otolaryngol Head Neck Surg 2023. [DOI: 10.1097/moo.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Chang YT, Shen CH. Total Intravenous Anesthesia and Postoperative Pulmonary Complications-Reply. JAMA Otolaryngol Head Neck Surg 2023; 149:376-377. [PMID: 36757716 DOI: 10.1001/jamaoto.2022.4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Yi-Ting Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Leong SL, Chen SH, Wei JCC. Total Intravenous Anesthesia and Postoperative Pulmonary Complications. JAMA Otolaryngol Head Neck Surg 2023; 149:375-376. [PMID: 36757753 DOI: 10.1001/jamaoto.2022.4964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Suet-Li Leong
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shih-Hsuan Chen
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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