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Anterior cricoid split: a "simple" surgical procedure and a potentially complicated care problem
The Annals of Otology, Rhinology, and Laryngology
|September 1, 1985
Summary
The anterior cricoid split (ACS) offers a viable alternative to tracheotomy for premature infants with airway issues post-extubation. While successful extubation rates vary, ACS shows promise for stable infants, though careful postoperative management is crucial.
Area of Science:
- Pediatric Surgery
- Neonatology
- Otolaryngology
Background:
- Upper airway compromise is a significant concern in premature infants following extubation.
- Tracheotomy is a common intervention, but alternatives are sought to minimize associated risks.
- The anterior cricoid split (ACS) procedure has been proposed as a less invasive option.
Observation:
- A study evaluated the outcomes of 16 premature infants undergoing ACS at CHNMC and 10 at other hospitals.
- Patient demographics included an average gestational age of 29 weeks and birth weight of 1,264g.
- Average intubation duration was 6.2 weeks for CHNMC patients.
Findings:
- Overall extubation success rates were 69% at CHNMC and 40% at other hospitals.
- For infants stable enough for discharge from NICU, extubation success after ACS was 75% in both groups.
- Complications included endotracheal tube malposition, increased ventilation needs, myocardial infarction, and subcutaneous emphysema.
Implications:
- The anterior cricoid split (ACS) can be a valuable procedure to avoid tracheotomy in select infants with subglottic airway narrowing and adequate pulmonary function.
- Postoperative care requires specialized expertise due to potential complications.
- Management by experienced teams familiar with respiratory insufficiency in infants is recommended.