An Audit of Extubation, Practices after Oral and Maxillofacial Surgery in a Nigeria Tertiary Centre

Abstract

Background: Perioperative airway management for maxillofacial surgery patients remains a challenge with potential risk of significant morbidity and mortality. Till date, universally acceptable protocol for managing extubation, is yet to be developed.

Aim: This study aimed to assess the extubation, practices in patients that had maxillofacial surgery in a tertiary health facility.  

Methods: Records of 102 consecutive patients that had oral and maxillofacial surgical procedures under general anaesthesia were collated prospectively. A proforma designed for the study was used to collect relevant perioperative anaesthetic and maxillofacial information.  

Results: Most extubation, occurred less than 4 hours (43.1%) or greater than 12 hours (45.1%) into the postoperative period. There was statistical significant relationship between postoperative period to extubation, and the indication for maxillofacial surgery (p = 0.001) and location of lesion (p = 0.003). More patients with surgery involving both anterior and posterior regions of the mandible, 21 (80.8%) had a postoperative to extubation, period of more than 12 hours. Postoperative period to extubation, had a positive correlation with duration of intubation (r=0.28, p=0.03) and moderate correlation with duration of surgical procedure. (r=0.36, p<0.001). Significant relationship was observed between postoperative period to extubation, and Mallampati score (p=0.001) and difficult mask ventilation (p=0.04).  

Conclusion: Some airway characteristics, choice of airway management and the site of surgical procedure were significant factors in determining the postoperative period to extubation. Postoperative period to extubation, did not determine the development of post-extubation, respiratory complications. With proper planning and management, some patients can be safely extubated relatively early in the postoperative period.