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Wang CMZ, Pang KP, Tan SG, Pang KA, Pang EB, Cherilynn TYN, Chan YH, Rotenberg BW. Predictors of difficulty in intubation in patients with obstructive sleep apnoea. Med J Malaysia 2019; 74:133-137. [PMID: 31079124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate predictors of difficult intubation in patients with obstructive sleep apnoea (OSA). METHODOLOGY Prospective series of 405 OSA patients (350 males/55 females) who had upper airway surgery. Procedures included functional endoscopic sinus surgery, septoplasty, turbinate reduction, palate/tonsil surgery, and/or tongue base surgery. Intubation difficulty (ID) was assessed using Mallampati grade, Laryngoscopic grade (Cormack and Lehane), and clinical parameters including BMI, neck circumference, thyromental distance, jaw adequacy, neck movements and glidescope grading. RESULTS Mean age was 41.6 years old; mean BMI 26.6; mean neck circumference 44.5cm; mean Apnea Hypopnea Index (AHI) was 25.0; and mean LSAT 82%. The various laryngeal grades (based on Cormack and Lehane), grade 1 - 53 patients (12.9%), grade 2A - 127 patients (31.0%), grade 2B - 125 patients (30.5%), grade 3 - 93 patients (22.7%) and grade 4 - seven patients (1.7%); hence, 24.4% had difficulties in intubation. Parameters that adversely affected intubation were, age of the patient, opening of mouth, retrognathia, overbite, overjet, limited neck extension, thyromental distance, Mallampati grade, and macroglossia (p<0.001). Body mass index (BMI) (p=0.087), neck circumference (p=0.645), neck aches (p=0.728), jaw aches (p=0.417), tonsil size (p=0.048), and AHI (p=0.047) had poor correlation with intubation. BMI-adjusted for Asians and Caucasians, showed that Asians were more likely to have difficulties in intubation (adjusted OR = 4.6 (95%Confidence Interval: 1.05 to 20.06) (p=0.043), compared to the Caucasian group. CONCLUSION This study illustrates that difficult intubation can be predicted pre-surgery in order to avert any anaesthetic morbidity.
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Affiliation(s)
- C M Z Wang
- Asia Sleep Centre, Department of Otolaryngology, Singapore.
| | - K P Pang
- Asia Sleep Centre, Department of Otolaryngology, Singapore
| | - S G Tan
- Asia Sleep Centre, Department of Anaesthesiology, Singapore
| | - K A Pang
- Asia Sleep Centre, Department of Otolaryngology, Singapore
| | - E B Pang
- Asia Sleep Centre, Department of Otolaryngology, Singapore
| | | | - Y H Chan
- National University Singapore, Yong Loo Lin School of Medicine, Biostatistics Unit, Singapore
| | - B W Rotenberg
- Western University, Head and Neck Surgery, Department of Otolaryngology, London, Ontario, Canada
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Araslanova R, Paradis J, Rotenberg BW. Publication trends in obstructive sleep apnea: Evidence of need for more evidence. World J Otorhinolaryngol Head Neck Surg 2017; 3:72-78. [PMID: 29204582 PMCID: PMC5683624 DOI: 10.1016/j.wjorl.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Published research in obstructive sleep apnea (OSA) appears limited despite OSA being a highly prevalent adult and pediatric disease leading to many adverse outcomes if left untreated. We aimed to quantify the deficit in OSA scientific literature in order to provide a novel way of identifying gaps in knowledge and a need for further research inquiry. Methods This was a Bibliometric analysis study. Using Ovid Medline database we analyzed and compared research output (medical and surgical) between adult OSA and similarly prevalent chronic conditions (Type II diabetes (T2DM), coronary artery disease (CAD) and osteoarthritis (OA)) from December 2016 up to fifty years prior. Linear graphs were utilized to trend collected data. Utilizing same strategy, we compared publication trends for pediatric OSA to asthma and gastroesophageal reflux (GER). Results Adult OSA publications (n = 9314) were significantly underrepresented when compared to T2DM (n = 66,023), CAD (n = 31,526) and OA (n = 34,123). Linear plots demonstrated that despite increasing number of publications this disparity persisted annually. Surgical literature composed 10.4% (n = 972) of adult OSA publications and reached a plateau in the last ten years. Pediatric OSA (n = 2994) had less research output when compared to asthma (n = 47,442) and GER (n = 6705). However, over past five years pediatric OSA surpassed GER in annual number of publications. Surgical literature represented 23.1% (n = 693) of pediatric OSA publications and continued increasing over past ten years. Study methodologies for both adult and pediatric OSA showed a lack of randomized controlled trials and meta-analyses in comparison to other diseases. Conclusion Our review shows substantial deficit in total, annual and surgical adult OSA published research compared to similarly prevalent diseases. This trend is not entirely observed in pediatric OSA literature.
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Affiliation(s)
- R Araslanova
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - J Paradis
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - B W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
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John-Baptiste A, Sowerby LJ, Chin CJ, Martin J, Rotenberg BW. Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis. CMAJ Open 2016; 4:E404-E408. [PMID: 27975045 PMCID: PMC5143022 DOI: 10.9778/cmajo.20150092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). METHODS We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. RESULTS The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. INTERPRETATION Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.
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Affiliation(s)
- A John-Baptiste
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - L J Sowerby
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - C J Chin
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - J Martin
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - B W Rotenberg
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
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Macdonald KI, Wright ED, Sowerby LJ, Rotenberg BW, Chin CJ, Rudmik L, Sommer DD, Nayan S, DesRosiers M, Tewfik MA, Valdes CJ, Massoud E, Thomas D, Kilty SJ, Vescan A, Mechor B, Lavigne F, Fandino M, Javer AR, Witterick IJ. Squeeze bottle versus saline spray after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial. Am J Rhinol Allergy 2015; 29:e13-7. [PMID: 25590308 DOI: 10.2500/ajra.2015.29.4125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a need for controlled trials to guide the perioperative management of patients undergoing endoscopic sinus surgery (ESS). The authors performed a pilot multicenter trial to compare two types of saline delivery devices in this population. METHODS Patients were randomized to high volume saline irrigation with a squeeze bottle and low volume saline spray after ESS in patients with chronic rhinosinusitis (CRS). Surgeons were blinded to treatment, and one-month postoperative scores for sinonasal outcomes [Sinonasal Outcome Test-22 (SNOT-22)] scale, nasal and sinus symptom score (NSS), and perioperative sinus endoscopy (POSE) scale were compared with preoperative scores. RESULTS Nine centers provided data for 86 patients. All three outcomes measures improved significantly for both groups. Saline spray: SNOT-22 48.8 versus. 23.7, treatment effect 25.1 (95% confidence interval [CI], 17.9-32.2), POSE 21.1 versus. 8.4, treatment effect 12.7 (95% CI, 9.2-16.1), and NSS 8.2 versus 5.0, treatment effect 3.1 (95% CI, 1.4-4.9) pre- and postoperatively, respectively (all p < 0.0001). Squeeze bottle: SNOT-22 49.5 versus 23.6, treatment effect 25.9 (95% CI, 20.3-31.6), POSE 18.6 versus 9.2, treatment effect 9.3, (95% CI 6.7-12.0), and NSS 9.0 versus 5.7, treatment effect 3.3 (95% CI, 2.3-4.3) pre- and postoperatively, respectively (all p < 0.0001). Analysis of variance did not identify a difference between the two treatment groups. Subgroup analysis based on preoperative disease severity did not change the nonassociation of saline bottle with outcome measures. Post hoc sample size calculation determined that 176 patients is required to detect an 8.9-point difference in SNOT-22 scores. CONCLUSION In this pilot multicenter trial examining patients with chronic rhinosinusitis undergoing ESS, both squeeze bottle and saline spray showed significant improvement in SNOT-22, POSE, and NSS scores at one-month postoperatively. Because the study was nonpowered, we cannot rule out a potential difference between the two treatment groups.
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Affiliation(s)
- K I Macdonald
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Canada ON
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Abstract
The superwet technique has been shown in previous studies to dramatically reduce blood loss in breast reduction surgery, compared with standard infiltration. A retrospective chart review of 303 consecutive patients undergoing bilateral breast reduction surgery was undertaken to demonstrate additional differences in complication rate, operative time, or sponge use in the operating room. In this series, 132 consecutive patients received standard infiltration along incision lines (25 cc per breast of 1:100,000 epinephrine), and 171 patients received superwet infiltration with 240 cc per breast of 1:1,000,000 epinephrine. The average operative time was significantly reduced in the superwet group, from 78.5 minutes to 70.7 minutes (p < 0.01 level). The average number of sponges used intraoperatively was also decreased significantly (p < 0.01), from 26 to 20 sponges. Complication rates were equally low in both groups, demonstrating the safety of the superwet technique. In addition to limiting blood loss, the superwet infiltration effectively reduces operative time and sponge use without increasing complications in breast reduction surgery.
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Affiliation(s)
- A D Armour
- Division of Plastic Surgery, Sunnybrook and Women's College Health Science Centre, Women's College Campus, University of Toronto, Ontario, Canada
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