A Retrospective Study of Airway Related Complications in Cervical Spine Surgery
Manee Raksakietisak MD1, Sirinuttakul Akkaworakit MD1, Saowapark Chumpathong MD1, Akkapong Nitising MD2, Arunotai Siriussawakul MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The purpose of the present study was to determine the incidences of perioperative airway related complications
(failed intubation, remained intubation and reintubation) and related factors for remained intubation in patients undergoing
cervical spine surgery.
Materials and Methods : We reviewed records of 253 patients undergoing cervical spine surgery from neurosurgery unit,
Siriraj hospital. The data, collected from January 2012 to May 2017, included patients’ demographics, perioperative airway
management, perioperative data, airway related complications and outcomes.
Results : Total 253 patients were analyzed. The mean age was 57.2+15.6 years, 55% were male; most patients were American
Society of Anesthesiologists [ASA] physical status II. The main diagnosis was cervical spondylotic myelopathy and the
main operation was anterior cervical discectomy and fusion. The intubations (missing = 11) were all successful with video
laryngoscope, fiberoptic bronchoscope, McIntosh direct laryngoscope and others. Remained intubation and reintubation
occurred 26.1% and 3.5%, respectively. Independent risk factors (odds ratio [OR]; 95% confidence interval [CI]) for
remained intubation were volume of crystalloid given >2,000 ml (OR 2.44; 95% CI 1.15 to 5.20), prolonged anesthetic time
>5 hours (OR 3.66; 95% CI 1.71 to 7.87), and finished after official service hours (OR 4.54; 95% CI 2.21 to 9.30). A little
more than half of the patients (51.8%) went to neurosurgical intensive care unit. Nine patients (3.5%) required reintubation.
Conclusion : With advanced airway equipment, the intubations were successful in cervical spine patients but postoperative
airway complications (remained intubation and reintubation) remained high and could not be neglected.
Keywords : Complications, Airway, Spine, Surgery, Intubation
