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Cuperus IE, Mathijssen IMJ, van Veelen MLC, Bouzariouh A, Stubelius I, Kölby L, Lundborg C, Das S, Johnson D, Wall SA, Larysz DF, Dowgierd K, Koszowska M, Schulz M, Gratopp A, Thomale UW, Zafra Vallejo V, Redondo Alamillos M, Ferreras Vega R, Apolito M, Vergnaud E, Paternoster G, Khonsari RH. A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure. Plast Reconstr Surg 2024:00006534-990000000-02238. [PMID: 38289904 DOI: 10.1097/prs.0000000000011317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. METHODS A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures. RESULTS Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 - 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. CONCLUSIONS Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.
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Affiliation(s)
- Iris E Cuperus
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Anouar Bouzariouh
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ingrid Stubelius
- Department of Anesthesiology and Intensive Care, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lundborg
- Department of Anesthesiology and Intensive Care, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sumit Das
- Department of Paediatric Anaesthesia, John Radcliffe Hospital, Oxford, United Kingdom
| | - David Johnson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Steven A Wall
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dawid F Larysz
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Krzysztof Dowgierd
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Małgorzata Koszowska
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin, Germany
| | - Alexander Gratopp
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin, Germany
| | - Víctor Zafra Vallejo
- Department of Oral and Maxillofacial Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Marta Redondo Alamillos
- Department of Oral and Maxillofacial Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Rubén Ferreras Vega
- Department of Anaesthesiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Michela Apolito
- Department of Maxillofacial Surgery and Plastic Surgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST); Faculty of Medicine, Paris Cité University, Paris, France
| | - Estelle Vergnaud
- Department of Pediatric and Obstetrical Anesthesiology and Reanimation, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST), Paris, France
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST); Faculty of Medicine, Paris Cité University, Paris, France
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