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COMPLICATIONS OF ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANESTHESIA IN TUBE-FED CHILDREN: A RETROSPECTIVE
Trang D Nguyen1, Marshall M Freilich, Bruce A Macpherson
1The Hospital for Sick Children, Toronto ON.
Insights
Children with aspiration risk needing enteral feeding face higher morbidity during oral and maxillofacial surgery under general anesthesia. Careful risk-benefit assessment is crucial before these procedures.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Oral and Maxillofacial Surgery
Background:
- Children with aspiration tendency requiring enteral feeding present unique challenges for surgical procedures.
- Oral and maxillofacial surgery under general anesthesia necessitates careful consideration of risks in this patient population.
Purpose of the Study:
- To evaluate the morbidity and mortality risks associated with oral and maxillofacial surgery performed under general anesthesia in children with a history of aspiration and enteral feeding.
- To inform surgical decision-making by quantifying adverse events in this specific pediatric cohort.
Main Methods:
- Retrospective chart review of 28 children undergoing 35 oral and maxillofacial surgery procedures.
- Data collected over a 9-year period (2000-2010) included demographics, medical conditions, procedures, airway management, and adverse events.
- Analysis focused on complications during or after general anesthesia in children with aspiration risk.
Main Results:
- No deaths were recorded among the 35 procedures.
- Ten procedures (29%) were associated with at least one adverse event.
- Adverse events included respiratory distress, fever, bleeding, seizures, and transient hypoxia (oxygen saturation <90%).
Conclusions:
- Children with aspiration tendency requiring enteral feeding are at an elevated risk of morbidity when undergoing oral and maxillofacial surgery under general anesthesia.
- Surgeons and guardians must weigh the potential benefits of surgery against these identified risks.
- This study highlights the need for heightened vigilance and tailored perioperative management for these vulnerable children.
Purpose:
To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding.
Material And Methods:
A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events.
Results:
During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s.
Conclusions:
Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.
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