Transoral LASER microsurgery - A retrospective analysis on perioperative complications and safety. (December 2020)

• Record Type: Journal Article
• Authors: Rocha, C.; Breda, E.; Cerejo, F.; Monteiro, E.; Miranda, L.
• Is Part Of: Trends in anaesthesia and critical care. Volume 35(2020)
• Page Start: 30
• Page End: 35
• Publication Date: 2020-12
• Subjects: Laser microsurgery -- Tracheal tubes -- LASER Safety -- Perioperative complications -- Airway fire; Anesthesia -- Periodicals; Critical care medicine -- Periodicals; Anesthesia in traumatology -- Periodicals; Anesthesia -- Case studies -- Periodicals; 617.9605
• DOI: 10.1016/j.tacc.2020.06.007
• Languages: English
• ISSNs: 2210-8440

Abstract

Abstract: Background: Complications associated with transoral LASER microsurgery (TLM) approach for head and neck tumours seems to be not completely understood namely those related with airway management and intubation. Aim: To evaluate the real dangers and safety problems associated with TLM. Methods: Evaluation of perioperative complications through a retrospective study involving all patients submitted to general anaesthesia with intubation for TLM for cancer of aerodigestive tract during a period of eleven years. Results: 1053 interventions met the inclusion criteria. At the end of the procedure, most of patients (97.3%) were extubated, 2.4% had postponed extubation and 0.3% had programmed tracheostomy. PVC microlaryngeal oral tracheal tubes (PVC-OTT) were used in 96% of cases. Only 28 major complications were registered, none being due to laser associated problems, namely airway ignition. Conclusions: TLM for cancer under general anaesthesia is associated with low incidence of major perioperative complications (2.7%), which are more relevant in the immediate postoperative period. Most of the patients may be extubated immediately, but in a few situations programmed postponed extubation or temporary tracheostomy may prevent some postoperative complications. The use of PVC –OTT was not associated with an increased risk of airway or equipment damage. Highlights: Airway management and intubation complications for TLM are not completely understood. Most publications about TLM anaesthesia are not based on analysis of patients series. Analysis of 1053 TLM interventions reported 2.7% major complications. Most of the patients may be extubated immediately. PVC microlaryngeal orotracheal tubes was not associated with major complications.