Are Temporary Tracheostomies a necessity for free flap surgery? (2016)

Type of publication:
Conference abstract

Author(s):
*Sandhu B.; *Mihalache G.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)

Abstract:
Controversy still surrounds the use of tracheosteomies in maxillofacial oncology surgery with free flaps. Many surgeons place tracheostomies in patients for airway protection post-operatively due to suspected swelling, removing the tube at approximately 10 days. However, patients undergoing this extensive surgery may not require routine tracheostomy and few maxillofacial units across the UK employ this principle. The aim of this study was to determine tracheostomy need within maxillofacial free flap surgery, and the associated complications, including extended recovery.A retrospective study was carried out of 40 patients whom underwent excision of tumours with free flap reconstruction from January 2013 to December 2015, with comparison to 2010-2012 where tracheostomies were routinely used. Analysis was made of hospital stay duration and post-operative complications.From the results of this study we can see that only 5% of cases underwent tracheostomies compared to 75% of the previous three years. All tracheostomy cases of 2013-2015 experienced chest or tracheostomy wound infections, compared to 31% of the 2010-2012 cases. The average hospital stay for those with temporary tracheostomies was 15-16 days and those without was 10 days for across the six years. There have been no reported cases of airway obstruction post-operatively in those cases where tracheostomies have not been placed following free flap surgery, including fibula free flaps. As a unit it has been concluded to avoid placing a temporary tracheostomy in all cases where possible. This is to avoid postoperative complications, reduce hospital stay and improve the quality of recovery from the patient’s perspective.

The use of a remifentanil infusion and elective tracheostomy to avoid ventilation in a patient with tetanus (2014)

Type of publication:
Journal article

Author(s):
*Redshaw C., *Slater R.

Citation:
Journal of the Intensive Care Society, April 2014, vol./is. 15/2(161-163), 1751-1437

Abstract:
Tetanus is very rare in developed countries but the mortality is still high in the elderly population despite access to intensive care medicine. Death can frequently occur from secondary complications due to the need to sedate, paralyse and ventilate patients in an effort to control spasms. We describe the case of a 77-year-old man with tetanus in whom we successfully controlled tetanic spasms with a remifentanil infusion where conventional treatment failed, thus preventing the need for mechanical ventilation. We also describe the use of an elective percutaneous tracheostomy which was performed for airway protection. This prevented him from developing pneumonia from aspirating the excess secretions caused by the autonomic features of tetanus.