Perioperative risk factors for postoperative pulmonary complications after major oral and maxillofacial surgery with microvascular reconstruction: A retrospective analysis of 648 cases

2016 ◽  
Vol 44 (8) ◽  
pp. 952-957 ◽  
Author(s):  
Denys J. Loeffelbein ◽  
Annette Julinek ◽  
Klaus-Dietrich Wolff ◽  
Eberhard Kochs ◽  
Bernhard Haller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Analysis ◽  
Maxillofacial Surgery ◽  
Pulmonary Complications ◽  
Perioperative Risk ◽  
Oral And Maxillofacial Surgery ◽  
Microvascular Reconstruction ◽  
Postoperative Pulmonary Complications ◽  
Perioperative Risk Factors

scholarly journals Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Antero Fernandes ◽  
Jéssica Rodrigues ◽  
Patrícia Lages ◽  
Sara Lança ◽  
Paula Mendes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Abdominal Surgery ◽  
Pulmonary Complications ◽  
Perioperative Risk ◽  
Postoperative Pulmonary Complications ◽  
Elective Abdominal Surgery ◽  
Perioperative Risk Factors

Abstract Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

scholarly journals Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

2020 ◽  
Author(s):  
Yun Liu ◽  
Xi Zhu ◽  
Dan Zhou ◽  
Fang Han ◽  
Xu Dong Yang
Keyword(s):  
High Risk ◽  
Free Flap ◽  
Maxillofacial Surgery ◽  
Pulmonary Complications ◽  
Oral And Maxillofacial Surgery ◽  
Flap Reconstruction ◽  
Postoperative Pulmonary Complications ◽  
Free Flap Reconstruction ◽  
Double Blind ◽  
Fibular Free Flap

Abstract Background: Postoperative pulmonary complications (PPCs) are common and significant problems for oral and maxillofacial surgery patients. Dexmedetomidine (DEX), an α2-adrenoreceptor agonist, has been proven having lung protection effects. However, since now, there has not been final conclusion about whether DEX can reduce the incidence of PPCs. We hypothesize that, in oral and maxillofacial surgery with fibular free flap reconstruction patients, DEX may decrease the incidence of PPCs.Methods: This was a prospective, double-blind, randomized, placebo-controlled, single-centered trial with two parallel arms. A total of 160 patients at intermediate-to-high risk of PPCs undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy were enrolled and randomized to receive continuous infusion of either DEX or placebo (normal saline). 0.4 ug/kg of DEX was given over 10mins as an initial dose followed by a maintaining dose of 0.4 ug/kg/h till the second day morning after surgery. At the same time, the normal saline was administered a similar quantity. The primary outcome was the incidence of PPCs according to Clavien-Dindo score within 7 days after surgery. Results: The two groups had similar characteristics at baseline. 18(22.5%) of 80 patients administered DEX, and 32(40.0%) of 80 patient administered placebo experienced PPCs within the first 7 days after surgery (relative risk [RR] 0.563,95% confidence interval [CI] 0.346-0.916; P=0.017). In the first 7 days after surgery, the DEX group had a lower incidence of PPCs and a better postoperative survival probability (Log-rank test, P=0.019), and was less prone to occur PPCs (Cox regression, P=0.025, HR=0.516). When the total dose of DEX was more than 328μg, the patients were unlikely to have PPCs (ROC curve, AUC=0.614, P=0.009).Conclusions: For patients undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy who were at intermediate or high risk of developing PPCs, continuous infusion of DEX could decrease the occurrence of PPCs during the first 7 days after surgery and shorten the length of hospital stay after surgery, but did not increase the prevalence of bradycardia or hypotension. Trial registration: Chinese Clinical Trial Registry, www.chictr.org.cn, number: ChiCTR1800016153; Registered on May 15, 2018.

scholarly journals Perioperative risk factors for pulmonary complications after non-cardiac surgery

2020 ◽  
Vol 36 (1) ◽  
pp. 88 ◽  
Author(s):  
Surbhi Gupta ◽  
RoshanJoseph Fernandes ◽  
JosephSushil Rao ◽  
Radhika Dhanpal
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Pulmonary Complications ◽  
Perioperative Risk ◽  
Perioperative Risk Factors

scholarly journals Comparison of the effects of intravenous and inhalational anesthesia on postoperative pulmonary complications after oral and maxillofacial surgery with free flap reconstruction: a double-blind, randomized, controlled trial

2019 ◽  
Author(s):  
Dan Zhou ◽  
Xi Zhu ◽  
Likuan Wang ◽  
Xudong Yang ◽  
Yun Liu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Relative Risk ◽  
Controlled Trial ◽  
Maxillofacial Surgery ◽  
Pulmonary Complications ◽  
Oral And Maxillofacial Surgery ◽  
Adjusted Relative Risk ◽  
Postoperative Pulmonary Complications ◽  
Double Blind ◽  
Randomized Controlled

Abstract Background: The effects of intravenous and inhalation anesthesia on intraoperative and postoperative pulmonary inflammatory responses have been reported in many studies. However, the differences in clinical postoperative pulmonary complications (PPCs) have rarely been studied, except in cases of lung resection. The main goal of the current study was to assess the impact of sevoflurane and propofol on the incidence of PPCs in patients undergoing oral and maxillofacial surgery. Methods: In this double-blind, randomized, controlled trial, we randomly assigned 220 adults at intermediate-to-high risk of pulmonary complications after oral and maxillofacial surgery to either propofol or sevoflurane as a general anesthetic. The occurrence of pulmonary complications according to the Clavien-Dindo score was defined as the primary (within 7 days after surgery) outcome. Results: The two intervention groups had similar characteristics at baseline. The PPCs incidence during 7 days after surgery was 32.4% and 18.2% in the propofol and sevoflurane groups, respectively (adjusted relative risk, 0.44; 95% confidence interval [CI], 0.22 to 0.91; P = 0.027). The corresponding incidence of PPCs in patients who underwent tracheotomy after surgery was 44.8% and 24.5% (adjusted relative risk, 0.39; 95% CI, 0.17 to 0.91; P = 0.030). Intergroup difference in the time to occurrence of the first PPC after surgery was significant (P = 0.021). There was no difference in postoperative hospital stay between the two groups. Conclusions: Compared with intravenous anesthesia, the administration of sevoflurane reduces the frequency of PPCs in intermediate-risk and high-risk patients undergoing oral and maxillofacial surgery with microvascular reconstruction. Trial registration: Clinical Trail Registration: ChiCTR1800015347; Registered March 25, 2018.

scholarly journals Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction: a prospective, double-blind, randomized, placebo-controlled trial

2019 ◽  
Author(s):  
Yun Liu ◽  
Xi Zhu ◽  
Dan Zhou ◽  
Fang Han ◽  
Xu Dong Yang
Keyword(s):  
Free Flap ◽  
Normal Saline ◽  
Maxillofacial Surgery ◽  
Pulmonary Complications ◽  
Oral And Maxillofacial Surgery ◽  
Flap Reconstruction ◽  
Postoperative Pulmonary Complications ◽  
Free Flap Reconstruction ◽  
Double Blind ◽  
Fibular Free Flap

Abstract Background: Postoperative pulmonary complications (PPCs) are common and significant problems for oral and maxillofacial surgery patients. Dexmedetomidine (DEX), an α2-adrenoreceptor agonist, has been proven having lung protection effects. However, since now, there has not been final conclusion about whether DEX can reduce the incidence of PPCs. We hypothesize that, in oral and maxillofacial surgery with fibular free flap reconstruction patients, DEX may decrease the incidence of PPCs.Methods: This was a prospective, double-blind, randomized, placebo-controlled, single-centered trial with two parallel arms. A total of 160 patients at intermediate-to-high risk of PPCs undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy were enrolled and randomized to receive continuous infusion of either DEX or placebo (normal saline). 0.4ug/kg dose of DEX was given over 10mins as an initial dose followed by a maintaining dose of 0.4ug/kg/h till the second day morning after surgery. At the same time, the normal saline was administered a similar quantity. The primary outcome was the incidence of PPCs according to Clavien-Dindo score within 7 days after surgery.Results: The two groups had similar characteristics at baseline. 18(22.5%) of 80 patients administered DEX, and 32(40.0%) of 80 patient administered placebo experienced PPCs within the first 7 days after surgery (relative ratio [RR] 0.563,95% confidence interval [CI] 0.346-0.916; P=0.017). In the first 7 days after surgery, the DEX group had a lower incidence of PPCs and a better postoperative survival probability (Log-rank test, P=0.019), and was less prone to occur PPCs (Cox regression, P=0.025, HR=0.516). When the total dose of DEX was more than 328μg, the patients were unlikely to have PPCs (ROC curve, AUC=0.614, P=0.009).Conclusions: Continuous infusion of DEX marks a huge decrease in the appearance of PPCs within the first 7days after surgery, for patients undergoing oral and maxillofacial surgery with fibular free flap reconstruction and tracheotomy.Trial registration: Chinese Clinical Trial Registry, www.chictr.org.cn, number: ChiCTR1800016153; Registered on May 15, 2018.

Sign in / Sign up

Export Citation Format

Share Document