Is Postoperative Orotracheal Intubation Necessary in Patients Who Underwent Transoral Robotic Surgery due to Obstructive Sleep Apnea Syndrome?

Objective: In this study we investigated whether postoperative changing nasotracheal to orotracheal intubation is necessary after trans-oral robotic surgery (TORS) for obstructive sleep apnea syndrome (OSAS). Methods: A total of 151 patients who underwent TORS between 2011 and 2023 with the diagnosis of OSAS were included. All patients were transferred to post anaesthesia intensive care unit (PACU) after operation with orotracheal (group O: 73 patients, operated between 2011 and 2017) or nasotracheal tubes (group N: 78 patients, operated between 2017 and 2023). Age, gender, American Society of Anesthesiologists scores, Mallampati scores, PACU stay, pH in arterial blood gas samples taken during this period (1--first hospitalization, 2-12 hours later, 3--before extubation), PC[O.sub.2], P[O.sub.2], Base excess (BE), lactate values, total amount of fluid administered, presence of complications, and discharge times were collected from the patients files. Statistical analyses were done between the groups. Results: There was no statistical difference between groups regarding patient's demographic data. The distribution of Mallampati scores of the patients was 52% in group O and 55% in group N (P = .97). Complication rate was 16% in group O (6 bleeding, 4 vomiting, 1 need for reintubation) and 19% in group N (6 bleeding, 7 vomiting, 2 need for reintubation). The length of stay in the PACU in both groups was 24.9 hours (P = .92). The amount of fluids given in PACU was not statistically different (P = .14). The length of hospital stay was the same in both groups (7 days). No statistical difference was observed between the 2 groups in any measurement period of arterial blood gas values, pH, P[O.sub.2], PC[O.sub.2], BE, and lactate. Conclusion: Our results support that nasotracheal intubation itself is safe both during surgery and postoperative period in OSAS patients who underwent TORS, and there is no need to change it to orotracheal intubation at the end of the operation. We believe that our study will contribute to the management of the early postoperative process in this patient group. Keywords: Anesthesia, endotracheal, robotic surgical procedures, obstructive sleep apnea