Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2022
Case ReportsAirway emergency from megaoesophagus: A rare complication of an adjustable gastric band.
A 77-year-old lady with a laparoscopic adjustable gastric band (LAGB), implanted 12 years earlier for obesity, developed an unusual but almost fatal complication, characterised by dysphonia and stridor within minutes and a tensely swollen anterior neck. The condition mimicked haemorrhage into the subcutaneous tissues of the neck, and the airway was secured with an awake fibreoptic intubation. Subsequent computed tomography imaging of the abdomen and chest revealed megaoesophagus with dilatation up to 7 cm, proximal to the gastric band. ⋯ In patients with LAGB in situ, fluid should be removed from the band for any suspected device-associated symptoms such as severe vomiting, severe gastro-oesophageal reflux or neck swelling and respiratory distress. When there is radiological evidence of gross oesophageal dilatation or a high likelihood of an obstructive pathology at the level of the band, a careful nasogastric tube decompression may also resolve reflux, neck swelling or respiratory distress. A complication associated with LAGB should be considered in a patient with unexplained neck swelling or other features of airway obstruction who has an LAGB in situ.
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Anaesth Intensive Care · Jul 2022
The association between unanticipated prolonged post-anaesthesia care unit length of stay and early postoperative deterioration: A retrospective cohort study.
This study aimed to investigate whether there was an association between an unanticipated prolonged post-anaesthesia care unit (PACU) length of stay and early postoperative deterioration, as defined as the need for a rapid response team activation, within the first seven days of surgery. We conducted a single-centre retrospective cohort study of adult surgical patients, who stayed at least one night in hospital, and were not admitted to critical care immediately postoperatively, between 1 July 2017 and 30 June 2019. A total of 11,885 cases were analysed. ⋯ Other factors associated with rapid response team activation included non-elective surgery (OR 1.78, P < 0.001) and theatre length of stay (OR per increment 1.61, P < 0.001). PACU length of stay was also independently associated with predefined complications and unplanned intensive care unit admission postoperatively. In our cohort, an unanticipated prolonged PACU length of stay of over one hour was associated with an increased incidence of rapid response team activation in the first seven days postoperatively.