Incidence and Profile of Postoperative Events in the Post-Anesthesia Care Unit after Ear, Nose, and Throat Surgery in Douala: Incidence et Profil des Evénements Postopératoires dans l'Unité de Soins Post-Anesthésiques après une Chirurgie Oto-Rhino-Laryngologique à Douala

Ngono Ateba Glwadys; Andjock Nkouo Yves christian; Metogo Mbengono junette arlette; Ndom Ntock ferdinand; Bilogui Adjessa Willy; Cassandre Tocko; Kuifo cedric; Passi Sone; Doui Kombo Rodrigue; Owono Etoundi Paul; ZE Minkande jacqueline

doi:10.5281/zenodo.18074696

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Abstract

ABSTRACT
Introduction. The Post-Anesthesia Care Unit (PACU) is a critical environment for managing patients in the immediate postoperative period. Patients undergoing Ear, Nose, and Throat (ENT) surgery are at a unique risk for specific complications. This study aimed to determine the incidence and characteristics of adverse events in the PACU among patients undergoing ENT surgery. Methodology. We conducted a prospective, single-center observational study between January 2023 and December 2024. All adult patients undergoing ENT surgery under general anesthesia and admitted to the PACU of Douala were screened for eligibility. Data on patient demographics, surgical characteristics, and the incidence of predefined postoperative events were systematically collected. Results. A total of 438 patients were initially assessed, of whom 112 met the inclusion criteria and were enrolled in the study. The majority of patients, 90 (80.4%), had an uneventful PACU course. However, 22 (19.6%) patients experienced at least one adverse event. The most common complications were severe pain (Numeric Rating Scale > 6), occurring in 12 (10.7%) patients, and postoperative nausea and vomiting (PONV), observed in 9 (8.0%) patients. Respiratory events, including airway obstruction or desaturation (SpO₂ < 92%), occurred in 5 (4.5%) patients. Cardiovascular instability and surgical site bleeding were less frequent, occurring in 4 (3.6%) and 2 (1.8%) patients, respectively. Conclusion. Nearly one in five patients undergoing ENT surgery experiences an adverse event in the PACU. Severe pain and PONV are the most frequent issues, but potentially life-threatening respiratory complications are a significant concern.
RÉSUMÉ
Introduction. L'unité de soins post-anesthésiques (USPA) est un environnement critique pour la prise en charge des patients dans la période postopératoire immédiate. Les patients subissant une chirurgie oto-rhino-laryngologique (ORL) courent un risque particulier de complications spécifiques. Cette étude visait à déterminer l'incidence et les caractéristiques des événements indésirables dans l'USPA chez les patients subissant une chirurgie ORL. Méthodologie. Nous avons mené une étude observationnelle prospective monocentrique entre janvier 2023 et décembre 2024. Tous les patients adultes subissant une chirurgie ORL sous anesthésie générale et admis dans l'unité de soins post-anesthésiques de Douala ont été sélectionnés pour déterminer leur éligibilité. Les données démographiques des patients, les caractéristiques chirurgicales et l'incidence des événements postopératoires prédéfinis ont été systématiquement recueillies. Résultats. Au total, 438 patients ont été initialement évalués, parmi lesquels 112 répondaient aux critères d'inclusion et ont été inclus dans l'étude. La majorité des patients, soit 90 (80,4 %), ont eu un séjour sans incident en salle de réveil. Cependant, 22 patients (19,6 %) ont présenté au moins un événement indésirable. Les complications les plus courantes étaient des douleurs intenses (échelle d'évaluation numérique > 6), survenant chez 12 patients (10,7 %), et des nausées et vomissements postopératoires (NVPO), observés chez 9 patients (8,0 %). Des événements respiratoires, notamment une obstruction des voies respiratoires ou une désaturation (SpO₂ < 92 %), sont survenus chez 5 patients (4,5 %). L'instabilité cardiovasculaire et les saignements au site opératoire ont été moins fréquents, survenant respectivement chez 4 (3,6 %) et 2 (1,8 %) patients. Conclusion. Près d'un patient sur cinq subissant une chirurgie ORL présente un événement indésirable en salle de réveil. La douleur intense et les NVPO sont les problèmes les plus fréquents, mais les complications respiratoires potentiellement mortelles constituent une préoccupation importante.

Keywords

Incidence Profile Post-operative events ENT Douala Incidence Profil évènements postopératoires ORL Douala

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Ngono Ateba Glwadys, Andjock Nkouo Yves christian, Metogo Mbengono junette arlette, Ndom Ntock ferdinand, Bilogui Adjessa Willy, Cassandre Tocko, … ZE Minkande jacqueline. (2026). Incidence and Profile of Postoperative Events in the Post-Anesthesia Care Unit after Ear, Nose, and Throat Surgery in Douala: Incidence et Profil des Evénements Postopératoires dans l’Unité de Soins Post-Anesthésiques après une Chirurgie Oto-Rhino-Laryngologique à Douala. HEALTH SCIENCES AND DISEASE, 27(Suppl 1). https://doi.org/10.5281/zenodo.18074696

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References

1. Bhattacharyya N. The increasing health care burden of adult sinonasal disease in the United States. Am J Rhinol. 2011;25(5):319-21.
2. Cramer JD, Johnson-Obaseki S, Cottrill E, et al. Trends in the surgical management of thyroid cancer. Laryngoscope. 2018;128(7):1741-1746.
3. Hines R, Barash PG, Watrous G, et al. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg. 1992;74(4):503-9.
4. Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291-307.
5. Nimmo AF, Absalom AR, Bagshaw O, et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia. 2019;74(2):211-224.
6. Camacho M, Noller MW, Wei JM, et al. Airway changes in patients with obstructive sleep apnea after surgical treatment: a systematic review and meta-analysis. Laryngoscope. 2017;127(11):2641-2649.
7. Sadhasivam S, Myer CM. Airway management and pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(10):1215-21.
8. Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-44.
9. Apfel CC, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.
10. Rose DK, Cohen MM, Wigglesworth DF, et al. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology. 1994;81(2):410-8.
11. Fleischmann E, Herbst F, Kugener A, et al. Postoperative nausea and vomiting is a risk factor for unplanned admission after ambulatory surgery in a retrospective registry analysis. Br J Anaesth. 2016;117(4):479-485.
12. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31.
13. Jarzyna D, Jungquist CR, Pasero C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118-145.e10.
14. Ganter MT, Hofer CK, Spahr-Schopfer I, et al. Development and validation of a score to predict the risk of postoperative complications in a surgical intensive care unit. Crit Care. 2005;9(4):R341-8.
15. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.
16. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91.
17. Card E, Panday G, Meng J, et al. A prospective observational study of the incidence and predictors of postoperative complications in the post-anaesthesia care unit. Can J Anaesth. 2015;62(1):42-50.
18. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS. Anesth Analg. 2019;128(6):1101-1103.
19. Odom-Forren J. A review of the literature on postoperative pain management. J Perianesth Nurs. 2006;21(2):101-10.
20. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85-113.
21. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth. 2004;51 (4):326-41.
22. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103 (1):33-9.

References

1. Bhattacharyya N. The increasing health care burden of adult sinonasal disease in the United States. Am J Rhinol. 2011;25(5):319-21.

2. Cramer JD, Johnson-Obaseki S, Cottrill E, et al. Trends in the surgical management of thyroid cancer. Laryngoscope. 2018;128(7):1741-1746.

3. Hines R, Barash PG, Watrous G, et al. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg. 1992;74(4):503-9.

4. Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013;118(2):291-307.

5. Nimmo AF, Absalom AR, Bagshaw O, et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia. 2019;74(2):211-224.

6. Camacho M, Noller MW, Wei JM, et al. Airway changes in patients with obstructive sleep apnea after surgical treatment: a systematic review and meta-analysis. Laryngoscope. 2017;127(11):2641-2649.

7. Sadhasivam S, Myer CM. Airway management and pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol. 2011;75(10):1215-21.

8. Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-44.

9. Apfel CC, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.

10. Rose DK, Cohen MM, Wigglesworth DF, et al. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology. 1994;81(2):410-8.

11. Fleischmann E, Herbst F, Kugener A, et al. Postoperative nausea and vomiting is a risk factor for unplanned admission after ambulatory surgery in a retrospective registry analysis. Br J Anaesth. 2016;117(4):479-485.

12. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617-31.

13. Jarzyna D, Jungquist CR, Pasero C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118-145.e10.

14. Ganter MT, Hofer CK, Spahr-Schopfer I, et al. Development and validation of a score to predict the risk of postoperative complications in a surgical intensive care unit. Crit Care. 2005;9(4):R341-8.

15. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

16. Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91.

17. Card E, Panday G, Meng J, et al. A prospective observational study of the incidence and predictors of postoperative complications in the post-anaesthesia care unit. Can J Anaesth. 2015;62(1):42-50.

18. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS. Anesth Analg. 2019;128(6):1101-1103.

19. Odom-Forren J. A review of the literature on postoperative pain management. J Perianesth Nurs. 2006;21(2):101-10.

20. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85-113.

21. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth. 2004;51 (4):326-41.

22. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103 (1):33-9.

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Incidence and Profile of Postoperative Events in the Post-Anesthesia Care Unit after Ear, Nose, and Throat Surgery in Douala

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