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Published on: August 2, 2024
Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children
XinYe Tang1,2,3,4, Yang Yang1,2,3,4, ZhiHai Zhang1,2,3,4
1Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
Single-stage laryngotracheal reconstruction (SS-LTR) using costal cartilage is effective for pediatric subglottic stenosis (SGS). Immediate post-operative extubation is safe and feasible for children with simple SGS.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Airway Surgery
- Pediatric Respiratory Medicine
Background:
- Subglottic stenosis (SGS) in children presents significant airway challenges.
- Single-stage laryngotracheal reconstruction (SS-LTR) is a surgical option for SGS.
- Determining the optimal timing for extubation post-SS-LTR is crucial for patient outcomes.
Purpose of the Study:
- To assess the feasibility of immediate extubation after SS-LTR in pediatric patients.
- To define appropriate indications for early extubation following SS-LTR for SGS.
- To evaluate the safety and efficacy of SS-LTR with anterior costal cartilage graft.
Main Methods:
- Retrospective analysis of 22 pediatric patients undergoing SS-LTR from July 2017 to July 2022.
- Inclusion of patients with varying grades of simple SGS, including congenital, acquired, and mixed etiologies.
- Analysis of pre-operative factors, surgical details, and post-operative outcomes including decannulation rates.
Main Results:
- All 22 patients were successfully extubated immediately post-anesthesia.
- The operation-specific decannulation rate was 90.9%, with an overall decannulation rate of 100%.
- SS-LTR with anterior costal cartilage graft demonstrated effectiveness for simple SGS Grades I-III.
Conclusions:
- Single-stage laryngotracheal reconstruction using anterior costal cartilage is an effective treatment for pediatric simple SGS.
- Immediate post-operative extubation following SS-LTR is a safe and feasible approach for select pediatric patients.
- This approach facilitates airway management and improves decannulation rates in children with subglottic stenosis.
Purpose:
To evaluate the feasibility and clarify the appropriate indications for extubation immediately after single-stage laryngotracheal reconstruction (SS-LTR) in pediatric subglottic stenosis (SGS).
Methods:
A retrospective study was performed from July 2017 to July 2022. All patients underwent SS-LTR with anterior costal cartilage graft. Information such as demographics, comorbidities, history of intubation or tracheostomy, Classification and grading of airway stenosis, the operation-specific decannulation rate and overall decannulation rate were analyzed.
Results:
Twenty-two patients with simple SGS were identified. The median age at SS-LTR was 19 months (IQR = 18.5 months). Fourteen patients (63.6%) were intubated prior to the presentation of symptoms. Fourteen patients (63.6%) required preoperative tracheostomy to maintain a secure airway. Eight patients (36.4%) had congenital SGS, 10 patients (45.5%) had acquired SGS, and 4 patients (18.2%) had mixed SGS. Three patients had Grade II stenosis. Nineteen patients had Grade III stenosis. Comorbidities were found in 10 patients (45.5%). Major comorbidities were pneumonia. Congenital airway anomalies were found in 6 patients (27.3%). After anesthesia, all 22 patients were successfully extubated and returned to the general ward. Twenty patients had a satisfactory airway after SS-LTR. Two patients required reintubation or tracheostomy after operation. Operation-specific decannulation rate was 90.9%. The overall decannulation rate is 100%.
Conclusion:
SS-LTR with anterior costal cartilage graft is an effective method to treat simple SGS ranging from Grades I to III in children. Extubation immediately after surgery is safe and feasible.
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