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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Perioperative complications of superior pharyngeal flap surgery in children
S M Valnicek1, R M Zuker, L M Halpern
1Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study reviewed surgical correction of velopharyngeal insufficiency in 219 children. Early complications like bleeding and airway obstruction were most common, occurring within 24 hours post-surgery.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Plastic Surgery
Background:
- Velopharyngeal insufficiency (VPI) often requires surgical intervention.
- Surgical correction aims to improve speech and swallowing.
- Perioperative complications can impact patient outcomes.
Purpose of the Study:
- To retrospectively review perioperative complications associated with VPI surgery.
- To identify the incidence and nature of early and late complications.
- To analyze factors contributing to adverse events.
Main Methods:
- Retrospective chart review of 219 pediatric patients undergoing VPI surgery.
- Data collected from 1985 to 1992.
- Analysis of complication types, timing, and management.
Main Results:
- Overall incidence of early complications was 16.4% (36/219).
- Most frequent early complications included postoperative bleeding (18 cases) and airway obstruction (20 cases), predominantly within 24 hours.
- Difficult intubation occurred in 6.4% (14/219); 3 patients required reintubation.
- Late complications included sleep apnea (9 cases), flap revision (7 cases), and pharyngoplasty take-down (4 cases).
- One death (0.45%) occurred in the cohort.
Conclusions:
- Early postoperative bleeding and airway obstruction are the primary complications following VPI surgery.
- Vigilant monitoring in the first 24 hours is crucial for managing these risks.
- Further research may explore strategies to mitigate these common perioperative issues.
Abstract:
A 7-year retrospective review of perioperative complications associated with surgical correction of velopharyngeal insufficiency was carried out. A total of 219 children who underwent surgery for velopharyngeal insufficiency between the years 1985 and 1992 were reviewed. Gender distribution was 58 percent male and 42 percent female. The mean age was 9.6 years, with a range of 4 to 22 years, at the time of surgery. Fourteen cases (6.4 percent) were considered a difficult intubation. There were 36 patients with early complications (16.4 percent incidence). Of these, 18 had postoperative bleeding and 20 developed airway obstruction. Most of these episodes occurred in the first 24 hours. Three patients required reintubation. Nine children developed sleep apnea after discharge. Four patients required take-down of the pharyngoplasty, while 7 others had revision of the flap. There was 1 death in the 219 patients. In summary, most complications following surgical correction of velopharyngeal insufficiency in our institution occur in the early postoperative period and are the result of bleeding and/or airway obstruction.
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