title: Airway adverse events following posterior occipito-cervical spinal fusion.
abstract: Management of the airway may be challenging in patients undergoing occipito-cervical spine fusions (OCF). Changes in the occipito-cervical angle (dOC2A) of fusion after surgery may result in acute airway obstruction, dyspnea and/or dysphagia. Objectives of the study were to review the airway management of patients during posterior OCF, determine the incidence, nature and risk factors for postoperative airway adverse events (AEs), and to determine the relationship between airway AEs and the change in dOC2A. In this retrospective cohort of 59 patients, following extubation in the operating room (OR), there were no complications in 43 (73%) patients (Group 1). Sixteen (27%) patients (Group 2) had airway complications; 4 requiring reintubation and 12 having delayed extubation. The number of vertebral levels fused (>6), presence of difficult intubation and duration of surgery (>5h) were significantly associated with AEs. There was no significant difference in the dOC2A between the groups (-1.070±5.527 versus -4.375±10.788, p=0.127). Airway management in patients undergoing OCF poses a challenge for the anesthesiology and surgical teams. The incidence of AEs was 27%. The decision to extubate immediately after surgery needs to be individualized. Factors such as difficult intubation, number of vertebral levels fused and duration of surgery have to be considered. A significant correlation between dOC2A and postoperative AEs could not be established. Risk factors for postoperative AEs are multifactorial and prospective evaluation of these factors is indicated.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Canada. Electronic address: drveena_4u@yahoo.co.in.
authors.forename: Veena
authors.initials: V
authors.lastname: Sheshadri
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Canada. Electronic address: Rebecca.Moga@uhn.ca.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moga
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Canada. Electronic address: Pirjo.Manninen@uhn.ca.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Manninen
authors.affiliation: Department of Orthopedic Surgery, Columbia, Missouri, United States. Electronic address: goldsteincl@health.missouri.edu.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Goldstein
authors.affiliation: Department of Surgery, Divisions of Orthopedic and Neurosurgery, Toronto Western Hospital, University of Toronto, Canada. Electronic address: Raja.Rampersaud@uhn.ca.
authors.forename: Yoga Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.affiliation: Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Spine Program, McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, Canada. Electronic address: Eric.Massicotte@uhn.on.ca.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Massicotte
authors.affiliation: Department of Surgery, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Spine Program, McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, Canada. Electronic address: Michael.Fehlings@uhn.ca.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Canada. Electronic address: Lashmi.Venkatraghavan@uhn.ca.
authors.forename: Lashmi
authors.initials: L
authors.lastname: Venkatraghavan
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Airway adverse events; Airway management; Occipito-cervical angle; Occipito-cervical complex; Occipito-cervical fusion