Postoperative Complications of Endoscopic Upper Airway Laser Surgery in Kasr Al-Ainy Hospital: A Prospective Study
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- Category: Vol. 83, March 2015
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Postoperative Complications of Endoscopic Upper Airway Laser Surgery in Kasr Al-Ainy Hospital: A Prospective Study, NEAAMAT I. ABD EL-RAHMAN, MOHAMED S. RIFAI, HASSAN M. AHMED, ABEER A. MOHAMED and SHYMAA F. ABD EL-FATTAH
Abstract
Background: Laser surgery of the upper airway is per-formed endoscopically under the microscope. One of the advantages of this type of surgery over an open partial tech-nique is that it only removes the lesion, preserving larger adjacent free areas and maintaining the laryngeal skeleton closed. However, because of the increase in the use of this technique for laryngeal and hypopharyngeal lesions, a greater number of complications may be expected. The aim of this study was to evaluate the incidence, type, and clinical signif-icance of postoperative complications of upper airway lesions treated with laser surgery.
Patients and Methods: Following approval of departmental ethics and research committee and obtaining written informed consent, sixty-six patients undergoing endoscopic airway laser surgery starting from January 2012 to December 2012 were included in the study. These patients were examined by the ENT consultant, diagnosed as having any airway pathology indicated for endoscopic airway laser surgery, and scheduled for surgical management. Routine investigations were per-formed preoperatively in addition to specific investigations related to the pathology including chest X-ray, indirect laryn-goscopy and arterial blood gases in addition to meticulous assessment of the airway. Patients with severe stridor, tracheo-stomised patients and patients with history of any previous anesthetic complications were excluded. Intraoperative stan-dard monitoring was performed, followed by induction in the presence of all equipments for difficult airway managment. Safety features for laser surgery were taken regarding the patient and medical personnel. Anesthesia was maintained and the patients were monitored for HR, BP, SaO2, EtCO2 and the postoperative complications related to airway man-agement, anesthetic management and surgical management.
Results: Postoperative complications were as follows; respiratory distress (e.g. tachypnea, working accessory respi-ratory muscles) (18%-twelve patients), ICU admission (6%- four patients), one patient had pneumothorax, another one had surgical emphysema and two were tracheostomised due to unrelieved airway oedema, all four patients were admitted in ICU under observation, and vomiting (9%-six patients).
Conclusion: Post-operative complications of endoscopic laser surgery of the upper airway are relatively low. Every anesthetist who is involved in this should have a clear concept of management for these complications, and strategies to avoid these complications should be performed.