EVALUATION OF THE FACTORS AND THE MANAGEMENT OF THE AIRWAY IN EMERGENCY ODONTOGENIC ABSCESS DEBRIDEMENTS 

Objective:
Analysis of the difficult intubation predictors, the airway management and the adult patient’s progress who were operated on for odontogenic abscess drainages and debridements, registered in emergency theatres in Bellvitge University Hospital (Barcelona, Catalonia).

Material and methods:
An observational, descriptive and retrospective study, carried out in two periods of 16 months, during the years 2010-11 and 2015-16. 
Several variables are included: difficult airway predictive factors (as trismus), related pathological background, type of abscess, intubation tools, extubation time and associated complications. The data are analyzed with 15 SPSS. The Kolmogorov Smirnov test was applied and a normal distribution was observed. Qualitative variables have been compared with Pearson's Chi-Square test while quantitative variables were compared with Pearson's correlation coefficient.

Results:
Data from 87 patients was collected (51 males, 36 females) during 32 months. The age varies from 20 to 83 years. The most important related personal background is to be a smoker (26%) and the second one is to be diabetic (8%). All patients underwent cervical CT scan, as well as intravenous drugs (antibiotic therapy, corticosteroids and non-steroidal anti-inflammatories) in the emergency room prior to the operation.
Intubation was performed using a fibreoptic bronchoscope in 55% of the cases. Macintosh standard laryngoscope was used in 21%. Blind nasotracheal intubation was applied in 17%. The 5% of patients were intubated with Airtraq® video laryngoscope. Remotely, tracheostomy and sedation (without protected secure airway) were performed.
The 85% of patients were extubated in the operating room. The 13% of patients could not be extubated in the operating room and required resuscitation units for immediate postoperative control. In any case reintubation was required. There were 5% of reoperations. The length of stay in hospital varied from 4 to 60 days. A statistically significant relationship was observed between the type of abscess and the extubation time (the 89% of patients with submandibular abscesses were extubated in the operating room).

Conclusions:
Airtraq® is a useful tool to take into account in the management of the airway in oropharyngeal abscesses despite trismus. However, the fibreoptic bronchoscope remains the most widely used device.
Smoking (the most common personal background) is not related to a higher rate of complications in the immediate postoperative period.
The obtained database becomes a guide for a future prospective study. Anticipated difficult intubation guidelines could be updated.
The paper was presented at the SEDAR (Spanish Society of Anaesthesiology) Congress 2017 and at the SCARTD (Catalonian Anaesthesiology Society) Congress in November 2016 as a communication.  
No potential conflict of interest reported.

Evaluation of the factors and the management of the airway in urgent debridements by odontogenic abscess during 32 months