Respiratory obstruction after posterior fossa surgery

Abstract

SummaryWe report a case, of acute upper airway obstruction after tracheal extubation 24 hours after surgery. The respiratory complications of surgery for posterior fossa lesions are discussed.

Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre

“…9 In addition, if there is any doubt about the integrity of bulbar function, the endotracheal tube should be kept in place for 24 h after surgery. 17 The high rate of delayed extubation in the present study suggests that the decision-making process in the authors' study centre may be over-conservative. It should be noted that 69.9% of patients included in the present report had tumours !30 mm in diameter, which is a higher rate than the 54% incidence reported elsewhere.…”

Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor

“…[6] Patients undergoing posterior fossa surgery are at an even higher risk of developing POPCs because of the interplay of other mechanisms like mechanical obstruction, central respiratory dysfunction, and neuromuscular dysfunction. [7] Obstructive sleep apnea has been reported in association with posterior fossa lesions. [8] The risk factors for POPCs in this group of patients have not been widely studied.…”

Extubation and Reintubation of the Difficult Airway

“…214 Howard and colleagues described a patient with a recurrent choroid plexus papilloma involving the fourth ventricle. 215 Preoperatively, the patient displayed bulbar dysfunction. His extubation on the first postoperative day was complicated by complete airway obstruction, hypoxia, and a seizure.…”

“…Posterior fossa surgery can cause injury to cranial nerves, bilateral vocal cord paralysis, brainstem or respiratory control center injury, and macroglossia. 114,115,167,[213][214][215][216] Because the nerve roots may be very close to the operative site, the resultant injuries may be bilateral, extensive, and transient or permanent. Gorski and coworkers suggested that tolerance of the ETT and the absence of a gag reflex on oral suctioning should arouse suspicion of such an injury.…”