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Available onlinehttp://ccforum.com/content/8/6/R385
December 2004Vol 8 No 6 Open Access Research The routine use of pediatric airway exchange catheter after extubation of adult patients who have undergone maxillofacial or major neck surgery: a clinical observational study 1 11 23 Levent Dosemeci, Murat Yilmaz, Arif Yegin, Melike Cengizand Atilla Ramazanoglu
1 Assistant Professor, Department of Anesthesiology and ICU, Akdeniz University Hospital, Antalya, Turkey 2 Specialist, Department of Anesthesiology and ICU, Akdeniz University Hospital, Antalya, Turkey 3 Professor, Director of Department of Anesthesiology and ICU, Akdeniz University Hospital, Antalya, Turkey
Corresponding author: Levent Dosemeci, leventege@yahoo.com
Received: 25 March 2004 Revisions requested: 6 May 2004 Revisions received: 29 July 2004 Accepted: 19 August 2004 Published: 22 September 2004
Critical Care2004,8:R385R390 (DOI 10.1186/cc2956) This article is online at: http://ccforum.com/content/8/6/R385
© 2004 Dosemeciet al.; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Introduction Weconducted the present study to determine the usefulness of routinely inserting a pediatric airway exchange catheter (PAEC) before tracheal extubation of adult patients who had undergone maxillofacial or major neck surgery and have risk factors for difficult reintubation. Methodsprospective, observational and clinical study was performed in the 25bed general A intensive care unit of a university hospital. Thirtysix adult patients who underwent maxillofacial or major neck surgery and had risk factors for difficult reintubation were extubated after insertion of the PAEC. ResultsFour of 36 (11.1%) patients required emergency reintubation after 2, 4, 6 and 18 hours after tracheal extubation, respectively. Reintubation of these patients, which was thought to be nearly impossible by direct laryngoscopy, was easily achieved over the PAEC. ConclusionThe PAEC can be a lifesaving device during reintubation of patients with risk factors for difficult reintubation such as laryngeopharyngeal oedema due to surgical manipulation or airway obstruction resulting from haematoma and anatomic changes. We therefore suggest the routine use of the PAEC in patients undergoing major maxillofacial or major neck surgery.
Keywords:airway exchange catheter, difficult intubation, maxillofacial surgery, neck surgery, reintubation
Introduction Maxillofacial and major neck surgery has a considerable risk for postoperative laryngopharyngeal oedema and airway obstruction due to surgical manipulation or haematoma [1]. When patients undergoing these operations develop laryngeal oedema or airway obstruction and require reintubation after they have been extubated, reintubation may be very difficult or impossible through laryngoscopy because of the characteris tics of these operations such as mandibular fixation with an archbar or as a result of anatomical changes. Extubation of a patient with risk factors for difficult tracheal reintubation is approached with concern, even in the experienced hands of
the anaesthesiologist and critical care physician. Although all of the criteria used to predict successful extubation are gener ally satisfactory before extubation, none predict the adequacy of the airway once the endotracheal tube (ETT) has been removed [2].
Hence, acute respiratory distress can develop after extubation and mandate emergency tracheal reintubation. Mask ventila tion and tracheal intubation may be difficult or impossible. Considerable time and an experienced physician are needed to secure a difficult airway with the use of alternative methods such as fibreoptic bronchoscope, retrograde] intubation or
ETT = endotracheal tube; ICU = intensive care unit; PAEC = pediatric airway exchange catheter
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