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Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the...

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Autores principales: Kennedy, Diana, Novak, Christine B., Phillips, John H., Der, Tara, Forrest, Christopher R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9870221/
https://www.ncbi.nlm.nih.gov/pubmed/36699209
http://dx.doi.org/10.1097/GOX.0000000000004784
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author Kennedy, Diana
Novak, Christine B.
Phillips, John H.
Der, Tara
Forrest, Christopher R.
author_facet Kennedy, Diana
Novak, Christine B.
Phillips, John H.
Der, Tara
Forrest, Christopher R.
author_sort Kennedy, Diana
collection PubMed
description Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the incidence and acute outcomes of catastrophic and critical events during craniofacial surgery at a single high-volume center. METHODS: The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed. RESULTS: This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients. CONCLUSIONS: Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities.
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spelling pubmed-98702212023-01-24 Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery Kennedy, Diana Novak, Christine B. Phillips, John H. Der, Tara Forrest, Christopher R. Plast Reconstr Surg Glob Open Craniofacial/Pediatric Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the incidence and acute outcomes of catastrophic and critical events during craniofacial surgery at a single high-volume center. METHODS: The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed. RESULTS: This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients. CONCLUSIONS: Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities. Lippincott Williams & Wilkins 2023-01-23 /pmc/articles/PMC9870221/ /pubmed/36699209 http://dx.doi.org/10.1097/GOX.0000000000004784 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Craniofacial/Pediatric
Kennedy, Diana
Novak, Christine B.
Phillips, John H.
Der, Tara
Forrest, Christopher R.
Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title_full Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title_fullStr Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title_full_unstemmed Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title_short Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery
title_sort catastrophic and critical intraoperative events during pediatric craniofacial surgery
topic Craniofacial/Pediatric
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9870221/
https://www.ncbi.nlm.nih.gov/pubmed/36699209
http://dx.doi.org/10.1097/GOX.0000000000004784
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