Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.465
Peer-review started: January 21, 2017
First decision: March 8, 2017
Revised: April 20, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: June 18, 2017
To review cases of emergent reintubation after cervical surgery.
Patients 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.
Eight 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.
Respiratory 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.
Core tip: The rate of cervical spine surgery has increased over the last years. Airway compromise is a rare but potentially life threatening complication following this type of procedure. This case series represents a single institution’s experience of 9 cases requiring emergent reintubation after anterior- or combined anterior-posterior cervical spine surgery. Besides reporting patient characteristics and operative details, our approach to evaluating and treating these cases is presented. In addition the literature addressing reintubation after cervical spine surgery is reviewed.