1996 OPEN FORUM Abstracts
Neonatal and Pediatric Airway Reconstruction: Procedural and Post-operative Management
Alan Seld, MD Monday, November 4, 1996
Single-staged laryngotracheoplasty is an accepted alternative to indwelling stents for the correction of acquired and congenital subglottic stenosis. Postoperative management is an important component in the successful evolution of single-stage laryngotracheoplasty. The role of the pediatric intensive care team in the management of these patients is divided into three phases:
1. Preoperative assessment. 2. Pediatric intensive care unit management. 3. Post-extubation care.
The preoperative phase incorporates:
1. Familiarization with the patient's family and family dynamics. 2. Evaluation of parental expectations. 3. Review of the preoperative plan. 4. Preoperative assessment: a. Pulmonary status b. Tracheal secretions for culture and sensitivity c. Reflux status and degree of control.
Following laryngotracheal reconstruction the patient is admitted to the pediatric intensive care unit. Integral in the concept of the single-stage laryngotracheal reconstruction are the following concepts:
1. Removal of the tracheotomy tube 2. Avoidance of any long-term indwelling stents 3. Ventilation of the patient during the immediate postoperative period via an endotracheal tube. 4. Removal of the endotracheal tube as soon as the laryngotracheal repair will tolerate. 5. Post-extubation airway therapy directed towards preventing reintubation.
It has been postulated that excessive movement of the endotracheal tube may result in friction at the site of the surgical reconstruction and may jeopardize the underlying repair. Also, the potential for accidental extubation after reconstructive surgery is a concern. Our unit uses intermittent neuromuscular blockade combined with sedation in an effort to prevent accidental extubation and prevent excessive movement.