The purpose of this study was to look at complications associated with percutaneous endoscopic gastrostomy (PEG) in a group of head and neck cancer patients. We retrospectively reviewed charts of 46 patients referred for PEG. Three of 29 patients without secured airways (10.3%) had acute airway obstruction after administration of sedation for the PEG procedure. Two required emergency tracheostomy. Three additional patients of these 29 (10.3%) presented within 2 months of their PEG attempts with tumor-related airway obstruction requiring emergency tracheostomy. There were no other serious complications noted in our review. We concluded that our group of head and neck cancer patients were at high risk for airway obstruction, especially when sedated, and that the acute risk was not directly associated with the PEG procedure. We also concluded that referral for PEG should be made in anticipation of future nutritional needs and that PEG should not be used only as a late-stage procedure.
\s=b\Recent increased concern regarding the risks of homologous blood transfusion led us to examine the use of blood products for head and neck tumor surgery. Major head and neck surgical procedures at three University of Washington (Seattle)\p=n-\ affiliated hospitals during 1987 were reviewed. Seventy-seven patients were identified. Parameters studied included the following: tumor site and stage, prior treatment, surgical procedure, preoperative and postoperative hematocrit values, estimated blood loss, operative and postoperative blood product use, and operative time. Data were grouped by procedure. Maxillectomy/midface procedures showed the highest average estimated blood loss (1037 mL) and the highest average blood use (1.5 units), followed by composite resections (883 mL and 0.8 units) and laryngectomies (724 mL and 0.9 units). When the data were subgrouped, larynogopharyngectomy (1450 mL and 4.0 units) and composite resection with mandibular swing (1300 mL and 1.0 units) showed the highest blood loss and blood product use. In the assessable groups, previous administration of radiation did not make a significant difference in blood loss or procedure time. However, blood loss correlated well with procedure time in all groups. The great majority of patients met all requirements to function as blood donors (84%). Sixty-five percent of patients met all criteria and used less than 2 units of blood, making autologous blood a reasonable option for the majority of patients with head and neck tumors.
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