Annali italiani di chirurgia
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Vocal cord injuries (VI), postoperative hoarseness (PH), dysphonia (DN), dysphagia (DG) and sore throat (ST) are common complications after general anesthesia; there is actually a lack of consensus to support the proper timing for post-operative laryngoscopy that is reliable to support the diagnosis of laryngeal or vocal fold lesions after surgery and there are no valid studies about the entity of laryngeal trauma in oro-tracheal intubation. Aim of our study is to evaluate the statistical relation between anatomic, anesthesiological and surgical variables in the case of PH, DG or impaired voice register. ⋯ Direct laryngoscopy is essential for the detection of arytenoid lesions after orotracheal intubation for general anesthesia. In our opinion, a part of temporary post-operative DN or PH is due to monolateral or bilateral arytenoids oedema, secondary to prolonged or difficult orotracheal intubation, valuable with laryngoscopy 72 hours after surgery. Is necessary to adjunct these complications in the surgical informed consensus scheme.
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Haemodynamically unstability after severe abdominal injuries requires a new therapeutic strategy. European guidelines recommend: reduced time, non-invasive investigations, avoid massive volemic replacement before surgery. The primary aim of Damage Control Resuscitation protocol is to prevent the lethal triad: hypothermia, acidosis and coagulopathy. The treatment includes contemporary: permissive hypotension, haemostatic resuscitation, and Damage Control Surgery (DCS). Systolic pressure below the physiological limits maximize the benefits of resuscitation and haemostasis, decreasing vessel clots expulsion. Haemostatic resuscitation uses blood components and substitutes, to allow volemic replacement and to avoid trauma-induced coagulopathy (25% - 30% of complex trauma). The use of PRBCs and plasma 1 to 1 is an independent survival predictor in patients undergoing DCS. Military haemostatic resuscitation protocol suggests massive transfusion using 10 or more PRBCs during 24 or 6 hours if 3 or more triggers are present: pressure > 90, hemoglobin > 11 g, temperature < 35.5°C, INR > 1.5, base deficit