{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:00:45Z","timestamp":1780452045793,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Midface advancements in children with syndromic craniosynostosis present challenges for anesthesiologists and intensive care teams.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study reviewed the perioperative airway management protocol for immediate tracheal extubation after midface surgery at our tertiary center over the past 10\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was performed to obtain information on respiratory disorders, surgical and anesthetic management, airway support, and respiratory complications following le Fort III (LF3) and monobloc (MB) with distraction. Patients with a tracheostomy were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two patients (12 LF3, 20\u2009MB) were included. All were immediately extubated with a median of 25\u2009min after surgery. Immediate extubation was performed in young patients (<jats:italic>n<\/jats:italic>\u2009=\u20098\/32, &lt;\u20095\u2009years old), in patients with severe OSA (<jats:italic>n<\/jats:italic>\u2009=\u20096\/32, median oAHI 23\/h), with difficult airways (<jats:italic>n<\/jats:italic>\u2009=\u20095\/32, Cormack\u2010Lehane airway grade\u2009\u2265\u20093), with significant intraoperative blood loss (<jats:italic>n<\/jats:italic>\u2009=\u200932, median 46\u2009mL\/kg), and with long operative times (<jats:italic>n<\/jats:italic>\u2009=\u200932, median 223\u2009min). The majority of patients received no or only oxygen support in the first hours after extubation (<jats:italic>n<\/jats:italic>\u2009=\u200929\/32) and could be discharged from the pediatric intensive care unit to the surgical ward after 1\u2009day (<jats:italic>n<\/jats:italic>\u2009=\u200930\/32). A 5\u2010month\u2010old patient with MB required intermittent oxygen and Guedel airway throughout his hospitalization due to airway obstruction at the tongue base combined with supine positioning to allow external traction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite the pre\u2010existing airway disorder, the extent of the procedure and the effect of anesthesia on airway tone, all patients were extubated immediately after midface advancement, with only one young patient needing prolonged postoperative support. Immediate extubation is feasible following midface advancement in patients with syndromic craniosynostosis. Further prospective randomized trials are needed to demonstrate superiority to delayed extubation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.15086","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T13:44:58Z","timestamp":1740145498000},"page":"380-388","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perioperative Airway Management for Midface Surgery in Children With Syndromic Craniosynostosis; a Single Center Experience With Immediate Extubation"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7980-941X","authenticated-orcid":false,"given":"Iris E.","family":"Cuperus","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery and Hand Surgery Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone E.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen F. M.","family":"Joosten","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eppo B.","family":"Wolvius","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Pullens","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene M. J.","family":"Mathijssen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery and Hand Surgery Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouar","family":"Bouzariouh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Sophia Children's Hospital\u2014Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2012-302745"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2015.11.004"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2011.04.017"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1597\/13-143"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-5876(99)00134-2"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-011-0504-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199909000-00006"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2014.05.010"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8118"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes308"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0741-9"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2009.03227.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14310"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011317"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.03.033"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.03.022"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25842"},{"key":"e_1_2_8_19_1","volume-title":"Very Early Monobloc: A Procedure for Extreme Conditions With Transfacial External Traction and Internal Distraction","author":"Arnaud E.","year":"2023"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2007.05221.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000053"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e318187c83a"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000244318.77377.67"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.1784"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13418"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199910000-00001"},{"issue":"8","key":"e_1_2_8_27_1","first-page":"339","article-title":"Relationship Between Severity of Illness and Length of Stay on Costs Incurred During a Pediatric Critical Care Hospitalization","volume":"68","author":"Hsu B. 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