Items 1 - 9 of 9

1. Ann Otol Rhinol Laryngol. 2019 Feb 13:3489419830118. doi:
10.1177/0003489419830118. [Epub ahead of print]

Perioperative Management of Total Laryngectomy Patients: A Survey of American
Head and Neck Society Surgeons.

Ahmed OH(1), Roden DF(1), Ahmed YC(2), Wang B(3), Nathan CO(4), Myssiorek D(2).

Author information: 
(1)1 Department of Otolaryngology-Head and Neck Surgery, New York University, New
York, NY, USA.
(2)2 Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College 
of Medicine, New York, NY, USA.
(3)3 Department of Population Health, Division of Biostatistics, New York
University, New York, NY, USA.
(4)4 Department of Otolaryngology-Head and Neck Surgery, Louisiana State
University, Shreveport, LA, USA.

OBJECTIVES:: Standards of care for total laryngectomy (TL) patients in the
postoperative period have not been established. Perioperative care remains highly
variable and perhaps primarily anecdotally based. The aim of this study was to
survey members of the American Head and Neck Society to capture management
practices in the perioperative care of TL patients.
METHODS:: In this survey study, an electronic survey was distributed to the
international attending physician body of the American Head and Neck Society.
Forty-five-question electronic surveys were distributed. A total of 777 members
were invited to respond, of whom 177 (22.8%) fully completed the survey. The
survey elicited information on management preferences in the perioperative care
of TL patients. Differences in management on the basis of irradiation status and 
pharyngeal repair (primary closure vs regional or free flap reconstruction) were 
ascertained. Main outcomes and measures were time to initiate oral feeding,
perioperative antibiotic selection and duration, and estimated pharyngocutaneous 
fistula rates. These measures were stratified by patient type.
RESULTS:: Most respondents completed head and neck fellowships (77.0%) and
practice at academic tertiary centers (72.3%). Ampicillin/sulbactam was the most 
preferred perioperative antibiotic (43.2%-49.1% depending on patient type),
followed by cefazolin and metronidazole in combination (32.0%-33.7%) and then
clindamycin (10.8%-12.6%). Compared with nonirradiated patients, irradiated
patients were significantly more likely to have longer durations of antibiotics (
P < .05), longer postoperative times to initiate oral feeding ( P < .05), and
higher estimated fistula rates ( P < .05). Additionally, in nonirradiated
patients, flap-repaired patients (vs primary repair) were significantly more
likely to have longer durations of antibiotics (odds ratio, 1.29; 95% confidence 
interval, 1.13-1.48) and postoperative times to initiate oral feeding (odds
ratio, 2.24; 95% confidence interval, 1.76-2.84).
CONCLUSIONS:: Perioperative management of TL patients is highly variable.
Management of antibiotics and oral feeding are significantly affected by
irradiation status and scope of pharyngeal repair. Further studies are needed to 
standardize perioperative care for this unique patient population.

DOI: 10.1177/0003489419830118 
PMID: 30758235 


2. J Craniomaxillofac Surg. 2019 Jan 18. pii: S1010-5182(18)31034-5. doi:
10.1016/j.jcms.2019.01.017. [Epub ahead of print]

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery:
Benefit or threat?

Goetz C(1), Burian NM(2), Weitz J(3), Wolff KD(4), Bissinger O(5).

Author information: 
(1)Department of Oral and Maxillofacial Surgery, Technische Universität München, 
Germany. Electronic address: cg.goetz@tum.de.
(2)Department of Oral and Maxillofacial Surgery, Technische Universität München, 
Germany. Electronic address: nora.m.burian@tum.de.
(3)Department of Oral and Maxillofacial Surgery, Technische Universität München, 
Germany. Electronic address: jochen.weitz@tum.de.
(4)Department of Oral and Maxillofacial Surgery, Technische Universität München, 
Germany. Electronic address: klaus.dietrich.wolff@tum.de.
(5)Department of Oral and Maxillofacial Surgery, Technische Universität München, 
Germany. Electronic address: oliver.bissinger@tum.de.

BACKGROUND: Temporary tracheotomies are often used in oral microvascular flap
reconstruction surgery to secure postoperative airway management and avoid
emergency tracheotomies. Even when planned electively, a tracheotomy can cause
severe and life-threatening complications. The aim of this study was to evaluate 
the complications of tracheotomies performed on oral cancer patients with
microvascular flap reconstructions and differentiated patterns, which could lead 
to postoperative complications.
METHODS: 150 patients, treated in the Department of Oral and Maxillofacial
Surgery from March 2017 to August 2018, were included in this study. Patient
records and perioperative data were analysed and the following specific items
were evaluated: time after surgery until removal of the tracheal cannula,
complications, cause and point of time of reinsertion of the cannula,
anticoagulative treatment, ASA grade (American Society of Anaesthesiologists),
TNM stage, and patient-specific data.
RESULTS: 30 patients (20%) developed tracheotomy-associated complications, most
commonly pneumonia (50%). There was a significant correlation between the time
period until removal of the cannula and the occurrence of complications such as
pneumonia and bleeding.
CONCLUSION: The results of our study lead us to recommend continuing to perform
temporary tracheotomies in oral cancer surgery with microvascular flap
reconstruction. The overall complication rate is low and postoperative airway
management can be performed in a safe and controlled manner. Nevertheless, the
time period for the inserted cannula should be kept as short as possible.

Copyright © 2019 European Association for Cranio-Maxillo-Facial Surgery.
Published by Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.jcms.2019.01.017 
PMID: 30755353 


3. Indian J Anaesth. 2019 Jan;63(1):65-66. doi: 10.4103/ija.IJA_559_18.

Superficial cervical plexus block for urgent tracheostomy.

Koshy RC(1), Thankamony H(1).

Author information: 
(1)Department of Anaesthesiology, RCC, Trivandrum, Kerala, India.

DOI: 10.4103/ija.IJA_559_18 
PMCID: PMC6341881
PMID: 30745618 

Conflict of interest statement: There are no conflicts of interest.


4. Indian Pediatr. 2018 Dec 15;55(12):1091-1092.

A Single Center Experience of Pediatric Tracheostomy.

Sharma PK(1), Vinayak N(2).

Author information: 
(1)Pediatric Critical Care and Pulmonology, Sri Balaji Action Medical Institute, 
New Delhi, India. drsharma025@gmail.com.
(2)Pediatric Critical Care and Pulmonology, Sri Balaji Action Medical Institute, 
New Delhi, India.

The feasibility and safety of pediatric tracheostomy care at home by parents is
challenging. Many physicians are not confident of sending tracheostomized
children home. We describe our experience with 12 children who underwent
tracheostomy and were sent home. Nine children were successfully decannulated.
With proper training of parents, the outcome of home tracheostomy seems good.


PMID: 30745485 


5. Korean J Anesthesiol. 2019 Feb 12. doi: 10.4097/kja.d.18.00276. [Epub ahead of
print]

Identifying the ideal tracheostomy site based on patient characteristics during
percutaneous dilatational tracheostomy without bronchoscopy.

Park J(1), Chung W(1)(2), Song S(1), Kim YH(1)(2), Lim C(1)(2), Ko Y(1)(2), Yun
S(1), Park H(1), Park S(1), Hong B(1)(2).

Author information: 
(1)Department of Anesthesiology and Pain Medicine, Chungnam National University
Hospital.
(2)Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam 
National University.

Background: We previously reported that percutaneous dilatational tracheostomy
(PDT) can be safely performed 2 cm below the cricothyroid membrane without the
aid of a bronchoscope. Although our simplified method is convenient and does not 
require sophisticated equipment, the precise location of tracheostomy cannot be
confirmed. Because it is recommended that tracheostomy be performed at the second
tracheal ring, we assessed whether patient characteristics could predict the
distance between the cricothyroid membrane and the second tracheal ring.
Methods: Data from 490 patients who underwent 3-dimensional neck computed
tomography (CT) from January 2012 to December 2015 were analyzed, and the linear 
distance from the upper part of the cricoid cartilage (CC) to the lower part of
the second tracheal ring (2TR) was measured in the sagittal plane.
Results: The mean CC-to-2TR distance was 25.26 mm (95% CI 25.02-25.48 mm). Linear
regression analysis showed that the predicted CC-to-2TR distance could be
calculated as - 5.73 + 0.2 × height (cm) + 1.22 × sex (male: 1, female: 0) + 0.01
× age (yr) - 0.03 × weight (kg) (adj. R2 = 0.55).
Conclusions: These results suggest that height and sex should be considered when 
performing PDT without bronchoscope guidance.

DOI: 10.4097/kja.d.18.00276 
PMID: 30744310 


6. J Bronchology Interv Pulmonol. 2019 Feb 6. doi: 10.1097/LBR.0000000000000547.
[Epub ahead of print]

Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is
Safe and Obviates the Need for Paralytics.

Sonti R(1), Sanley M, Vinayak A.

Author information: 
(1)Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown
University Hospital, Washington, DC.

BACKGROUND: Bedside percutaneous tracheostomy (PT) placement in critically ill
patients is performed in a variety of ways, largely driven by institutional
preference. We have recently transitioned to primarily extubating the patient and
placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of
retracting the endotracheal tube (ETT) in place. This allows for lower sedative
use and provides a superior view of the operative field. Here, we seek to
describe the safety and efficiency of that approach.
METHODS: This is a single-center cross-sectional study from 2014 to 2016
comparing patients who underwent PT with the ETT in place retracted to the
proximal larynx versus those who were extubated and had a LMA placed. Procedural 
length, sedative totals, and safety outcomes were recorded.
RESULTS: In total, 125 patients underwent PT during the study period, 75 via a
LMA and 50 via existing ETT. There was no difference in procedural duration (LMA:
53.5±21.4 min vs. ETT: 50.4±16.8; P=0.41), total complications (LMA: 29.3% vs.
16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was
significantly lower in the LMA arm (LMA: 1.0±3.6 mg vs. ETT: 11.5±5.9 mg;
P<0.01).
CONCLUSION: Replacing the ETT with an LMA before PT is equally safe, does not
increase total procedural duration, and all but eliminates the need for paralytic
agents.

DOI: 10.1097/LBR.0000000000000547 
PMID: 30741843