Emergent reintubation following elective cervical surgery: A case series

Abstract

AIMTo review cases of emergent reintubation after cervical surgery.METHODSPatients who were emergently intubated in the post-operative period following cervical surgery were identified. The patients’ prospectively documented demographic parameters, medical history and clinical symptoms were ascertained. Pre-operative radiographs were examined for the extent of their pathology. The details of the operative procedure were discerned.RESULTSEight hundred and eighty patients received anterior- or combined anterior-posterior cervical surgery from 2008-2013. Nine patients (1.02%) required emergent reintubation. The interval between extubation to reintubation was 6.2 h [1-12]. Patients were kept intubated after reintubation for 2.3 d [2-3]. Seven patients displayed moderate postoperative edema. One patient was diagnosed with a compressive hematoma which was subsequently evacuated in the OR. Another patient was diagnosed with a pulmonary effusion and treated with diuretics. One patient received a late debridement for an infected hematoma. Six patients reported residual symptoms and three patients made a complete recovery.CONCLUSIONRespiratory compromise is a rare but potentially life threatening complication following cervical surgery. Patients at increased risk should be monitored closely for extended periods of time post-operatively. If the airway is restored adequately in a timely manner through emergent re-intubation, the outcome of the patients is generally favorable.

Variation in Prevertebral Soft Tissue Swelling after Staged Combined Multilevel Anterior–Posterior Complex Cervical Spine Surgery: Anterior Then Posterior (AP) versus Posterior Then Anterior–Posterior (PAP) Surgery

“…Wewel et al reported that, out of seventy-two patients who underwent PAP and AP surgeries, six had delayed extubation, and three had reintubation [ 32 ]. The reintubation of 9 patients out of 880 that underwent elective cervical surgery, 3 of whom underwent combined anterior–posterior surgery, was also reported by Schroeder et al [ 33 ]. In all of these accounts, the combined anterior–posterior surgery procedure was performed in a single stage.…”

A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation

“…Schroeder et al concluded that if a secure airway is restored quickly, the patients’ outcomes are mostly favorable. 18 Prior to extubation, the medical team should have an airway management plan in place in the event airway compromise occurs and reintubation is necessary. This plan should include having advanced airway devices immediately available, staff trained to identify at risk patients, and access to a surgeon capable of performing a surgical airway.…”

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery

“…Airway obstruction following postoperative extubation following anterior cervical spine surgery represents a much-dreaded complication. It has many potential causes and is particularly concerning to surgeons because of its potential to quickly progress to respiratory arrest and death complicating a procedure that most of the time is considered “straightforward.” Airway complication rates are quoted around 1% of all anterior cervical procedures, usually restricted to 1- or 2-level pathology and are frequently discussed in the literature in the context of outpatient anterior cervical surgery and its safety [ 18 , 19 ]. This has led authors to identify patients at-risk for unplanned reintubation.…”