title: Postoperative complications associated with extubation strategies following palatoplasty: a single-center retrospective analysis.
abstract: OBJECTIVE
  Palatoplasty carries a high risk of airway obstruction as a postoperative complication. Since 2007, the protocol in our hospital has been to leave an endotracheal tube in place after surgery while the patient is moved to the pediatric intensive care unit. Extubation is then performed after achievement of hemostasis and recovery of consciousness. We compared the cases over the 5-year periods before and after the introduction of this revised postsurgical management plan to investigate its effect on postoperative complications.
  
  
  METHODS
  This was a retrospective cohort study involving a single pediatric hospital. The subjects were 199 children aged 1-3 years, who underwent palatoplasty between January 2002 and July 2012. Changes in the incidence rates of postoperative complications were statistically examined.
  
  
  RESULTS
  There were significantly more postoperative complications among the patients who were extubated in the operating room than among those extubated in the intensive care unit (operating room group, 22/94 cases; intensive care unit group, 10/105 cases; P < 0.01). Serious complications, such as hypoxemia and airway obstruction, also occurred more frequently in the operating room group.
  
  
  CONCLUSIONS
  Extubation in an intensive care unit was possibly associated with a reduction in postoperative complications.
authors.affiliation: Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8660, Japan. takumaroz@gmail.com.|Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan. takumaroz@gmail.com.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kishimoto
authors.affiliation: Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8660, Japan.
authors.forename: Takamori
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8660, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8660, Japan.
authors.forename: Ikuya
authors.initials: I
authors.lastname: Ueta
authors.affiliation: Department of Plastic Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Susam
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Anesthesiology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Horimoto
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D000402:Airway Obstruction / Q000150:complications; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D009873:Operating Rooms; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk
keywords: Airway obstruction; Cleft palate; Pediatric intensive care unit; Perioperative care; Postoperative complications