title: A comparative study of early and late extubation following transoral odontoidectomy and posterior fixation.
abstract: OBJECTIVE
  Elective ventilation is the usual practice after transoral odontoidectomy (TOO) and posterior fixation. This practice of elective ventilation is not based on any evidence. The primary objective of our study was to find out the difference in oxygenation and ventilation in patients extubated early compared to those extubated late after TOO and posterior fixation. The secondary objectives were to compare the length of Intensive Care Unit (ICU)/hospital stay and pulmonary complications between the two groups.
  
  
  METHODS
  After TOO and posterior fixation, patients were either extubated in the operating room (Group E) or extubated next day (Group D). The oxygenation (PaO2:FiO2 ratio) and ventilation (PaCO2) of the two groups before surgery, at 30 min and at 6/12/24 and 48 h after extubation were compared. Complications, durations of ICU and hospital stay were noted.
  
  
  RESULTS
  The base-line PaO2:FiO2 and PaCO2 was comparable between the groups. No significant change in the PaO2:FiO2 was noted in the postoperative period in either group as compared to the preoperative values. Except for at 12 h after surgery, there was no significant difference between the two groups at various time intervals. No significant change in the PaCO2 level was seen during the study period in either group. PaCO2 measured at 30 min after surgery was more in Group E (37.5 ± 3.2 mmHg in Group E vs. 34.6 ± 2.9 mmHg in Group D), otherwise there was no significant difference between the two groups at various time intervals. One patient in Group E (7.1%) and two patients in Group D (13%) developed postoperative respiratory complication, but the difference was not statistically significant. The mean ICU stay (Group D = 42 ± 25 h vs. Group E = 25.1 ± 16.9 h) and mean hospital stay (Group D = 9.9 ± 4 days vs. Group E = 7.6 ± 2.2 days) were longer in Group D patients.
  
  
  CONCLUSIONS
  Ventilation and oxygenation in the postoperative period in patients undergoing TOO and posterior fixation are not different between the two groups. However, the duration of ICU and hospital stay was prolonged in group D.
authors.affiliation: Department of Neuroanaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Marda
authors.affiliation: Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mihir Prakash
authors.initials: MP
authors.lastname: Pandia
authors.affiliation: Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Girija Prasad
authors.initials: GP
authors.lastname: Rath
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shashank Sharad
authors.initials: SS
authors.lastname: Kale
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
authors.forename: Harihara
authors.initials: H
authors.lastname: Dash
keywords: Atlanto-axial dislocation; craniovertebral junction; delayed extubation; early extubation; transoral odontoidectomy; ventilation