Perioperative management of patients undergoing tracheal resection and reconstruction: a retrospective observational study
Manejo perioperatório de pacientes submetidos à ressecção e reconstrução traqueal: um estudo observacional retrospectivo
Juan C. Segura-Salguero; Lorena Díaz-Bohada; Álvaro J. Ruiz
Abstract
Background
Perioperative management of Tracheal Resection and Reconstruction (TRR) presents many challenges to the physicians involved in airway management. Factors related to postoperative outcomes can be identified as early as the preoperative setting and can even be linked to demographic characteristics of patients affected by tracheal stenosis. The primary aim of this study is to describe the experience of patients undergoing TRR at our hospital from an anesthesiology perspective, describing as a second aim demography, preoperative conditions, and postoperative complications.
Methods
This was a single institution retrospective review of patients who underwent TRR between 2009 and 2020. We did a post-hoc exploratory analysis to identify possible associations between perioperative complications and perioperative management.
Results
Forty-three ASA I–IV adult patients aged 18–72 years who underwent TRR were included. Prolonged intubation (72%) is the primary cause of tracheal stenosis. Intraoperative management: intravenous induction and laryngeal masks are now the most frequently used for airway management, especially in subglottic stenosis. Perioperative complications were vocal cord paralysis (25.6%), postoperative ventilatory support (20.9%), and need for surgical reintervention (20.9%). One patient (2%) died in the postoperative period due to anastomotic complication. After resection, dexmedetomidine is the preferred choice (48.8%) for sedoanalgesia in the ICU.
Conclusions
Perioperative management of TRR at our hospital has a low mortality and high morbidity rate. We did not find an association between perioperative anesthetic interventions and postoperative complications. Further studies are needed to evaluate which anesthetic interventions may be associated with better outcomes.
Keywords
Resumo
Justificativa: O manejo perioperatório da ressecção e reconstrução traqueal (RRT) apresenta muitos desafios para os médicos envolvidos no manejo das vias aéreas. Fatores relacionados aos resultados pós-operatórios podem ser identificados já no cenário pré-operatório e podem até mesmo estar ligados às características demográficas dos pacientes acometidos por estenose traqueal. O objetivo principal deste estudo é descrever a experiência dos pacientes submetidos à RRT em nosso hospital na perspectiva da anestesiologia, descrevendo como segundo objetivo a demografia, condições pré-operatórias e complicações pós-operatórias. Métodos: Esta foi uma revisão retrospectiva de uma única instituição de pacientes submetidos a RRT entre 2009 e 2020. Fizemos uma análise exploratória post-hoc para identificar possíveis associações entre complicações perioperatórias e manejo perioperatório. Resultados: Quarenta e três pacientes adultos ASA I-IV com idade entre 18 e 72 anos submetidos a RRT foram incluídos. A intubação prolongada (72%) é a principal causa de estenose traqueal. Manejo intraoperatório: a indução intravenosa e as máscaras laríngeas são hoje as mais utilizadas para o manejo das vias aéreas, especialmente na estenose subglótica. As complicações perioperatórias foram paralisia das cordas vocais (25,6%), suporte ventilatório pós-operatório (20,9%) e necessidade de reintervenção cirúrgica (20,9%). Um paciente (2%) faleceu no pós-operatório por complicação da anastomose. Após a ressecção, a dexmedetomidina é a escolha preferencial (48,8%) para sedoanalgesia na UTI. Conclusões: O manejo perioperatório da RRT em nosso hospital tem baixa mortalidade e alta morbidade. Não encontramos associação entre intervenções anestésicas perioperatórias e complicações pós-operatórias. Mais estudos são necessários para avaliar quais intervenções anestésicas podem estar associadas a melhores resultados.
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References
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