Perioperative care following complex laryngotracheal reconstruction in infants and children

Gupta, Punkaj; Tobias, Joseph D.; Goyal, Sunali; Kuperstock, Jacob E.; Hashmi, Sana; Shin, Jennifer J.; Hartnick, Christopher J.; Noviski, Natan

doi:10.4103/1658-354x.71577

Cited by 7 publications

(3 citation statements)

References 56 publications

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“…The management of our highly complex patient was possible due to the multidisciplinary approach and the preparation prior to the procedure of the otorhinolaryngology, anesthesia, and critical care group [22], [23], [24], [25], [26].…”

Section: Discussionmentioning

confidence: 99%

Total laryngectomy in neonate with laryngeal sarcoma: perioperative management: Case report

2023

Rev. chil. anest.

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Newborn airway related diseases are one of the biggest challenges that an anesthesiologist can face during his medical practice. This case report describes a complete airway obstruction in a neonate with a laryngeal sarcoma who underwent various diagnostic procedures, finally receiving a total laryngectomy as part of his oncological treatment. We document the perioperative care during the laryngectomy, a procedure that has not yet been reported in literature to the date. We share our experience on how to confront such challenge and review the current literature on laryngeal cancer in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Total laryngectomy in neonate with laryngeal sarcoma: perioperative management: Case report

2023

Rev. chil. anest.

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“…With widespread use of open surgical techniques, decannulation rates surpass 90% . To achieve a successful outcome, the perioperative treatment of these patients requires coordinated, multidisciplinary care …”

Section: Introductionmentioning

confidence: 99%

“…Following LTR, the patient is often nasotracheally intubated, requiring analgesia and sedation, with or without neuromuscular blockade. This level of pharmacologic restraint helps minimize excessive neck and endotracheal tube movement, which could disrupt suture lines and cartilage grafts, cause mucosal trauma, or result in accidental extubation . The length of intubation, and subsequently sedation and analgesic needs, varies from 3 to 9 days, depending on the type of airway reconstruction .…”

Section: Introductionmentioning

confidence: 99%

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement

Bowe

Colaianni

Yamasaki

et al. 2019

JAMA Otolaryngol Head Neck Surg

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Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation.OBJECTIVE Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR). DESIGN, SETTING, AND PARTICIPANTSA standardized sedation weaning protocol was previously developed and instituted in February 2013. To address healthcare system-wide changes, a 7-step, Institute for Healthcare Improvement methodology was used to reevaluate a series of measures comparing a previous postweaning group (2013-2014; 13 patients) and current post-EHR group (2016; 11 patients). We conducted a focus group review of these 24 patients. MAIN OUTCOMES AND MEASURESThe primary outcome measure was length of sedation weaning. Secondary outcome, process, and balance measures included total length of sedation, absence of standardized wean document, absence of specific recommendations on weaning regimen, length of stay, continued weaning at discharge, discharge location, absence of discharge instructions on weaning regimen or iatrogenic withdrawal syndrome (IWS), discharge within 72 hours of stopping weaning, and readmission. RESULTSThe postweaning and post-EHR groups were similar in age (20.5 months [95% CI,), as well as male sex (11 of 13 [85%] vs 10 of 11 [91%]), respectively. In the post-EHR group, the standardized sedation wean document was missing from 9 of 11 (82%) medical records. However, the primary outcome measure, length of sedation weaning, remained stable at 9.45 (95% CI, 7.62-11.29) days in the post-EHR group compared with 9.08 (95% CI, 7.00-11.18) days in the postweaning group. In addition, only 5 of 11 (46%) of discharges in the post-EHR group had specific guidance on weaning since the standardized template was no longer in use. As a result, in the post-EHR group, patients were 15.2 (95% CI, 0.46-242.34) times as likely to lack discharge instructions on weaning or IWS.CONCLUSIONS AND RELEVANCE Quality improvement is meant to be a continuous process in which reevaluation of care practices are regularly performed. System-wide redesign can be achieved using a formal methodological approach. Moving forward, notable QI opportunities for our institution included the development of a flexible sedation weaning template, as well as enhancements to discharge instructions to include IWS diagnosis and treatment.

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Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children

Tang

Yang

Zhang

et al. 2023

Eur Arch Otorhinolaryngol

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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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Perioperative care following complex laryngotracheal reconstruction in infants and children

Cited by 7 publications

References 56 publications

Total laryngectomy in neonate with laryngeal sarcoma: perioperative management: Case report

Total laryngectomy in neonate with laryngeal sarcoma: perioperative management: Case report

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement

Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children

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