Airway Events and Critical Care Requirements in Patients with Robin Sequence after Palatoplasty

Author:

Cohen Stephanie M.1,Kanack Melissa2,Nussbaum Lisa3,Nguyen Tyler T.3,Resnick Cory M.3,Park Raymond4,Evans Faye4,Rogers-Vizena Carolyn R.3,Ganske Ingrid M.3

Affiliation:

1. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.

2. Division of Pediatric Plastic Surgery, Rady Children’s Hospital, University of California, San Diego, Calif.

3. Department of Plastic and Oral Surgery, Boston Children’s Hospital. Boston, Mass.

4. Department of Anesthesiology, Boston Children’s Hospital. Boston, Mass.

Abstract

Background: Patients with Robin sequence (RS) are often thought to be at high-risk for airway complications after cleft palate repair, and may be routinely admitted to the intensive care unit after surgery. This study compares frequency of postoperative airway events in patients with and without RS undergoing palatoplasty, and assesses potential risk factors for needing intensive care. Methods: A matched cohort study of patients with and without RS undergoing palatoplasty from February 2014 to February 2022 was conducted. Variables of interest included prior management of micrognathia, comorbidities, polysomnography, age and weight at the time of palatoplasty, operative techniques, intubation difficulty, anesthesia duration, and postoperative airway management. Airway events were defined as airway edema, secretions, stridor, laryngospasm, obstruction, and/or desaturation requiring intervention. Logistic regression was performed to identify factors predictive of airway events. Results: Thirty-three patients with RS and 33 controls were included. There were no statistically significant differences in airway events between groups (eight RS, four controls, P = 0.30). Anesthetic duration over 318 minutes was associated with increased risk of postoperative airway events [(OR) 1.02 (1.00–1.04) (P = 0.04)] for patients with RS, but not for patients in the control cohort. Conclusions: Postoperative intensive care unit admission is not universally necessary for patients with RS after palatoplasty if intubation was straightforward and there were no concomitant procedures being performed. Patients with longer anesthesia durations were more likely to have postoperative airway events and may need a higher level of care postoperatively.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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