Document Detail


Immediate postoperative extubation in patients undergoing free tissue transfer.
MedLine Citation:
PMID:  21433018     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES/HYPOTHESIS: Extubation (cessation of ventilatory support) is often delayed in free flap patients to protect the microvascular anastomosis, presumably by reducing emergence-related agitation. We sought to determine if immediate extubation in the operating room (OR) would improve the postoperative course compared to delayed extubation in the intensive care unit (ICU).
STUDY DESIGN: Retrospective chart review.
METHODS: Medical records of all patients undergoing free tissue transfer for head and neck reconstruction between January 2009 and July 2010 were reviewed (n = 52). Patients extubated immediately postoperatively in the OR (immediate group, n = 26) were compared to patients extubated in the ICU (delayed group, n = 26).
RESULTS: Tobacco use, alcohol use, pulmonary history, case length, and free flap type were not significantly different between the two groups. Although the average ICU stay for the immediate group was significantly shorter than the delayed group (2.0 days vs. 3.4 days; P = .008), the reduction in overall hospital stay for the immediate group did not achieve statistical significance (8.2 days vs. 9.5 days; P = .21). Use of treatment for agitation (27% vs. 65%) and physical restraints (8% vs. 69%) were significantly lower in the immediate versus delayed group (P = .01 and P < .001, respectively). Although flap-related, surgical, and medical complication rates were not significantly different between the two groups, the delayed extubation group had a significantly higher incidence of pneumonia (15% vs. 0%; P = .05).
CONCLUSIONS: Immediate postoperative extubation in the OR following head and neck microvascular free tissue transfer reduces ICU stay, anxiolytic use, restraint use, and incidence of pneumonia without an increase in flap- or wound-related complications. Laryngoscope, 2011.
Authors:
Amir Allak; Tam N Nguyen; David C Shonka; James F Reibel; Paul A Levine; Mark J Jameson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Laryngoscope     Volume:  121     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  763-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, U.S.A.
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