Setting: Tertiary care hospital, Singapore.
Synopsis: The records of 487 consecutive adult patients undergoing nasal and palatal surgery with (NPT) and without (NP) tongue base surgery for OSA were reviewed for complications. Those undergoing NP were monitored for six hours after surgery and discharged, while those undergoing NPT were monitored in a step-down unit overnight. In total, 7 percent of patients had complications, including oxygen desaturation (1.2 percent), persistent hypertension (3.1 percent), postobstructive pulmonary edema (0.4 percent), tongue swelling (1.8 percent), airway obstruction (0.2 percent) and bleeding (3.1 percent). All desaturations occurred within 180 minutes after surgery. All of the tongue swelling and airway obstruction complications were secondary to tongue suspension suture placement.
While the authors acknowledge that narcotics make post-operative respiratory complications more likely, they do not document how pain was managed in these patients. They also make a number of suggestions for post-operative care but include no analysis supporting these findings. Finally, they suggest close post-operative monitoring for three hours in the recovery room to determine whether admission to a surgical floor or increased monitoring environment is necessary.