title: Airway complications associated with surgery on the anterior cervical spine.
abstract: METHODS
  Retrospective chart review of 311 anterior cervical procedures.
  
  
  OBJECTIVE
  To assess the incidence and variables that predispose to an airway complication in a large series of anterior cervical surgical procedures.
  
  
  BACKGROUND
  A rare but potentially lethal complication after anterior cervical spine surgery is respiratory compromise and airway obstruction. Some risk factors are thought to include two-level corpectomy in myelopathic patients with a history of heavy smoking and asthma. No previous study in the literature has been directed at examining the factors specifically related to airway complications after anterior cervical spine surgery.
  
  
  METHODS
  Each chart was examined for patient characteristics and pathology, anesthetic parameters and problems, operative procedure, and postoperative course and management. Statistical analysis was performed.
  
  
  RESULTS
  Nineteen patients (6.1%) had an airway complication and six (1.9%) required reintubation. One patient died. Symptoms developed on average 36 hours postoperatively. All complications except for two were attributable to pharyngeal edema. Variables that were found to be statistically associated with an airway complication (P < 0.05) were exposing more than three vertebral bodies, a blood loss >300 mL, exposures involving C2, C3, or C4, and an operative time >5 hours. A history of myelopathy, spinal cord injury, pulmonary problems, smoking, anesthetic risk factors, and the absence of a drain did not correlate with an airway complication.
  
  
  CONCLUSIONS
  Patients with prolonged procedures (i.e., >5 hours) exposing more than three vertebral levels that include C2, C3, or C4 with more than 300-mL blood loss should be watched carefully for respiratory insufficiency.
authors.affiliation: University of California, San Francisco-Fresno Medical Education Program, Fresno, California, USA. eversosaggy@cs.com
authors.forename: H Claude
authors.initials: HC
authors.lastname: Sagi
authors.forename: William
authors.initials: W
authors.lastname: Beutler
authors.forename: Eben
authors.initials: E
authors.lastname: Carroll
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Connolly
mesh_terms: D000328:Adult; D017677:Age Distribution; D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D002574:Cervical Vertebrae / Q000601:surgery; D015897:Comorbidity; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D017678:Sex Distribution; D012907:Smoking; D013122:Spinal Diseases / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D014139:Tracheostomy / Q000706:statistics & numerical data