J Reconstr Microsurg 2013; 29(02): 131-136
DOI: 10.1055/s-0032-1329927
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Alcohol Withdrawal Syndrome and Neuropsychological Disorder in Patients after Head and Neck Cancer Ablation Followed by Microsurgical Free Tissue Transfer

Chang-Cheng Chang
1   Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Chia-yi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Huang-Kai Kao
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Jung-Ju Huang
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Chung-Kan Tsao
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Ming-Huei Cheng
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
,
Fu-Chan Wei
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

25. Juli 2012

19. August 2012

Publikationsdatum:
31. Dezember 2012 (online)

Abstract

Purpose The use of microsurgical free flap reconstruction has resulted in improved patient outcomes and survival after head and neck cancer resection. Although postoperative care in an intensive care unit (ICU) for airway management and flap surveillance can increase the success rate, any accompanying neuropsychological problems can potentially affect the outcome.

Materials and Methods From January 2006 to December 2008, we retrospectively reviewed 1,506 ICU patients who underwent head and neck cancer ablative surgery followed by microsurgical free tissue transfer. Twelve patients (Group A) had alcohol withdrawal syndrome (AWS), whereas 29 patients (Group B) had other neuropsychological problems. The clinical manifestations and outcomes of each group were investigated and statically analyzed.

Results All the flaps survived. There was no significant difference in onset time, duration, ICU stay, hospital stay interval, overall complications, and flap circulation-related complications. However, the non–flap-related complication rates (10/12, 83.3%; 14/29, 48.3%; p = 0.038), including failure of extubation or ventilator weaning (7/12, 58.3%; 7/29, 24.1%; p = 0.036), were significantly higher in Group A.

Conclusion Patients with postoperative AWS have a higher chance of developing non–flap-related complications, especially respiratory problems. The identification of a multidisciplinary approach to identify and manage these patients preoperatively and postoperatively is required.

 
  • References

  • 1 Blacher RS. The psychological and psychiatric consequences of the ICU stay. Eur J Anaesthesiol Suppl 1997; 15: 45-47
  • 2 Weber RJ, Oszko MA, Bolender BJ, Grysiak DL. The intensive care unit syndrome: causes, treatment, and prevention. Drug Intell Clin Pharm 1985; 19: 13-20
  • 3 Shiu MN, Chen TH, Chang SH, Hahn LJ. Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. Br J Cancer 2000; 82: 1871-1874
  • 4 Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. J Oral Pathol Med 1995; 24: 450-453
  • 5 Kuo YR, Jeng SF, Lin KM , et al. Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder. Ann Surg Oncol 2008; 15: 371-377
  • 6 Tonnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg 1999; 86: 869-874
  • 7 Soderstrom CA, Smith GS, Kufera JA , et al. The accuracy of the CAGE, the Brief Michigan Alcoholism Test, and the Alcohol Use Disorders Identification Test in screening trauma center patients for alcoholism. J Trauma 1997; 43: 962-969
  • 8 Weinfeld AB, Davison SP, Mason AC, Manders EK, Russavage JM. Management of alcohol withdrawal in microvascular head and neck reconstruction. J Reconstr Microsurg 2000; 16: 201-206
  • 9 Lansford CD, Guerriero CH, Kocan MJ , et al. Improved outcomes in patients with head and neck cancer using a standardized care protocol for postoperative alcohol withdrawal. Arch Otolaryngol Head Neck Surg 2008; 134: 865-872
  • 10 Mayo-Smith MF, Beecher LH, Fischer TL , et al; Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164: 1405-1412
  • 11 Thompson WL, Johnson AD, Maddrey WL. Diazepam and paraldehyde for treatment of severe delirium tremens. A controlled trial. Ann Intern Med 1975; 82: 175-180
  • 12 DiPetrillo P, McDonough M. Alcohol Withdrawal Treatment Manual. Glen Echo, MD: Focused Treatment System; 1999
  • 13 Blacher RS. The psychological and psychiatric consequences of the ICU stay. Eur J Anaesthesiol Suppl 1997; 15: 45-47
  • 14 Weber RJ, Oszko MA, Bolender BJ, Grysiak DL. The intensive care unit syndrome: causes, treatment, and prevention. Drug Intell Clin Pharm 1985; 19: 13-20
  • 15 McKegney FP. The intensive care syndrome. The definition, treatment and prevention of a new “disease of medical progress.”. Conn Med 1966; 30: 633-636
  • 16 Gelling L. Causes of ICU psychosis: the environmental factors. Nurs Crit Care 1999; 4: 22-26
  • 17 Justic M. Does “ICU psychosis” really exist?. Crit Care Nurse 2000; 20: 28-37 , quiz 38–39