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Anesthesia for subglottic stenosis in pediatrics.

Eid EA - Saudi J Anaesth (2009)

Bottom Line: Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea.Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction.Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia Liver Institute, Menoufia University, Egypt, Assoc Professor, Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

ABSTRACT
Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofluraneor propofol-based total intravenous anesthesia.

No MeSH data available.


Related in: MedlinePlus

Subglottic edema
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Figure 0006: Subglottic edema

Mentions: Before starting surgical manipulation, infants received IV dexamethaszone 0.3 mg/kg, and were exposed to GER assessment by recording the endoscopic signs of reflux (edema and erythema of the arytenoids and trachea, loss of outline of the tracheal rings, and blunting of the carina) and the pH changes were recorded by a four-channel (Castell)-type solid-state manometer catheter, with esophageal motility analysis software for lower and upper esophageal sphincter dual-sensor pH catheters (Medtronic Functional Diagnostics, Shoreview, Minn). At the end of surgery, the infants were intubated with an endotracheal tube (ETT) that permitted air leakage at 20 cm H2O and shifted to the neonatal intensive care unit (NICU). Extubation was performed after 24 hours of mechanical ventilation. Cases with obvious laryngeal and subglottic edema [Figures 6 and 7] should be ventilated for 48 hours to provide time for the edema to resolve. Tracheal extubation for all cases should be done in the Operating Room (OR) theater, where all the facilities for emergency and tracheostomy are available.[20]


Anesthesia for subglottic stenosis in pediatrics.

Eid EA - Saudi J Anaesth (2009)

Subglottic edema
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2876945&req=5

Figure 0006: Subglottic edema
Mentions: Before starting surgical manipulation, infants received IV dexamethaszone 0.3 mg/kg, and were exposed to GER assessment by recording the endoscopic signs of reflux (edema and erythema of the arytenoids and trachea, loss of outline of the tracheal rings, and blunting of the carina) and the pH changes were recorded by a four-channel (Castell)-type solid-state manometer catheter, with esophageal motility analysis software for lower and upper esophageal sphincter dual-sensor pH catheters (Medtronic Functional Diagnostics, Shoreview, Minn). At the end of surgery, the infants were intubated with an endotracheal tube (ETT) that permitted air leakage at 20 cm H2O and shifted to the neonatal intensive care unit (NICU). Extubation was performed after 24 hours of mechanical ventilation. Cases with obvious laryngeal and subglottic edema [Figures 6 and 7] should be ventilated for 48 hours to provide time for the edema to resolve. Tracheal extubation for all cases should be done in the Operating Room (OR) theater, where all the facilities for emergency and tracheostomy are available.[20]

Bottom Line: Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea.Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction.Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia Liver Institute, Menoufia University, Egypt, Assoc Professor, Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.

ABSTRACT
Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofluraneor propofol-based total intravenous anesthesia.

No MeSH data available.


Related in: MedlinePlus