Pediatric airway reconstruction is undertaken to correct airway obstruction, which may be congenital or iatrogenic. Congenital airway obstruction can be located at any level of the respiratory system, from the nares to the bronchi. It can be complete obstruction, such as choanal atresia in a newborn, or incomplete, such as adenotonsillar hypertrophy or tracheomalacia. Iatrogenic obstruction is often the result of prolonged intubation in a premature infant, which results in subglottic stenosis (SGS) after extubation. As these children grow, their airway growth may not keep pace, resulting in restrictive symptoms limiting their activity. Laryngotracheoplasty (LTP) or tracheal resection procedures may be needed to reconstruct and enlarge the airway. If the premature infant has concurrent lung disease, long-term intubation is often followed by tracheostomy placement. The timing of decannulation depends on the patient's airway patency and respiratory reserve. Understanding the process of evaluation and treatment of patients with SGS helps the anesthetist provide safe anesthesia for this challenging group of children.
Chapter. 2195 words. Illustrated.
Subjects: Anaesthetics ; Paediatrics
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