Background: Airway management and anesthesia during endolaryngotracheal surgery in patients with obstructive airway diseases pose a major challenge for anesthesiologists, especially in pediatric patients. Children with obstructive airway disease often have a potentially difficult airway. Adequate airway assessment and preparation before anesthesia is essential. In the formulation of the entire anesthesia strategy, the choice of ventilation mode is the most critical. Superimposed high-frequency jet ventilation (SHFJV) is an enormous step forward in the progress of difficult surgery of the larynx and trachea in neonates, infants and children. However, due to objective factors, it has not been extensively applied worldwide.
Case Description: In this article, our airway management strategy and clinical anesthesia experience is presented in a precisely designed, non-invasive and "tubeless" supraglottic SHFJV technique. This technique was used during a successful endolaryngotracheal surgery in a 3-year-old child with congenital subglottic stenosis under total intravenous anesthesia (TIVA) with propofol and remifentanil. Ultimately, the entire procedure and anesthesia were successful, and the child received effective treatment.
Conclusions: By summarizing and sharing our airway management strategy and clinical anesthesia experience in this case, anesthesiologists may have a clearer understanding of the challenges in this type of surgery. This case may add a valuable reference for the extensive application of SHFJV in endolaryngotracheal surgery.
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http://dx.doi.org/10.21037/tp-22-218 | DOI Listing |
Transl Pediatr
December 2022
Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
Background: Airway management and anesthesia during endolaryngotracheal surgery in patients with obstructive airway diseases pose a major challenge for anesthesiologists, especially in pediatric patients. Children with obstructive airway disease often have a potentially difficult airway. Adequate airway assessment and preparation before anesthesia is essential.
View Article and Find Full Text PDFClin Otolaryngol
August 2015
Department of Otorhinolaryngology/Head and Neck Surgery, Medical University of Hannover, Hannover, Germany.
Objective: High-frequency jet ventilation (HFJV) arose as a ventilation alternative in laryngotracheal surgery as it offers the surgeon a better overview and more space for microsurgical manipulations. On the contrary, anaesthesiologic monitoring is limited and (relative) contraindications exist. The aim of this study was to evaluate the procedure.
View Article and Find Full Text PDFPaediatr Anaesth
October 2007
Division of Anaesthesiology for Neurosurgical and Craniofacial Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Background: Endolaryngotracheal surgery in neonates, infants and children poses a big challenge for both anesthesiologist and surgeon. The narrowness of the airways and the great variability of the pathological lesions necessitate close collaboration between the surgical and the anesthesia team to provide optimal operating conditions and ensure adequate ventilation and oxygenation.
Methods: Sixty-two anesthetic records of endolaryngotracheal surgical procedures in neonates, infants and children with ASA physical status 1-3 were analyzed retrospectively.
Int J Pediatr Otorhinolaryngol
October 1993
Département d'Oto-Rhino-Laryngologie, de chirurgie cervico-faciale et de Phoniatrie, Hopital E. Herriot, Lyon, France.
Twelve cases of childhood subglottic stenosis diagnosed either acquired or congenital were treated using an endolaryngotracheal Montgomery T-tube. Stenting lasted on average 5.6 months.
View Article and Find Full Text PDFJ Trauma
January 1993
Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Republic of China.
A surgical technique of laryngotracheoplasty with long-term stenting was employed exclusively in the treatment of 105 patients with laryngotracheal stenosis in the Department of Otolaryngology, National Taiwan University Hospital from May 1977 to April 1989. The results were satisfactory, 92% of the treated patients being decannulated. The technique of laryngotracheoplasty can be summarized as follows: (1) Exposure of the stenotic region by laryngofissure, anterior and/or posterior cricoid splitting, vertical tracheal incision; (2) debridement of infected soft tissue; (3) relaxation or displacement of heavy scar tissue; (4) placement of sutures to tent the laryngotracheal mucosal remnants to the extraluminal region; (5) insertion of a endolaryngotracheal stent using a silicone T tube; (6) closure of the skin layer of the surgical wound only, without approximating the soft tissue layer between the T tube and skin; and (7) leaving the stent in place for at least 6 months.
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