Sedation-related outcomes in postoperative management of pediatric laryngotracheal reconstruction

Sedation after airway reconstruction in children: A protocol to reduce withdrawal and length of stay

“…The mean LOS among this cohort compared favorably to prior series and is similar to outcomes reported in older, unsedated patients. 1,[3][4][5][6]11 Most importantly, this protocol demonstrated efficacy in young children (0-5 years), with little or no modifications necessary other than weight-based dosing. Moreover, this care pathway may be applied to a variety of complex airway surgeries.…”

“…1,5,6 Proponents of early mobilization and less sedation cite a lower rate of ventilator-acquired pneumonia, neuropathy/myopathy, pressure necrosis of the skin, and narcotic or benzodiazepine withdrawal. 3,4 Prolonged sedation in the neonatal intensive care unit in particular is growing out of favor, with increasing concerns regarding the effect of sedatives on the developing brain. [7][8][9] However, sedation risks need to be weighed against patient discomfort during an unsedated or undersedated period of intubation as well as the risk for accidental extubation and manipulation of the surgical site.…”

“…Our goal herein was to describe a protocol that we feel allows for the benefits of deep sedation and paralysis without the medical complications previously associated with complex airway surgeries. 1,[3][4][5][6] During the 2-year study period, postoperative care following 16 major airway surgeries was managed with this protocol, with each recovery requiring a postoperative sedation period of at least 3 days. Rates of readmission and unplanned return to the operating room were similar to or lower than previous reports.…”

“…In reference to laryngotracheal reconstruction in particular, several studies have advocated for minimal sedation and avoidance of paralytics in older children. However, it is understood that postoperative sedation is required in infants, toddlers, and children who are incapable of understanding instructions to limit movement and avoid manipulation of the nasotracheal tube . Often, there exists significant variation in practice among critical care physicians and surgeons, even within the same hospital, in terms of sedation agents used, duration of intubation, and use of paralytics following airway surgeries that require a period of postoperative sedation .…”

“…3,4 Often, there exists significant variation in practice among critical care physicians and surgeons, even within the same hospital, in terms of sedation agents used, duration of intubation, and use of paralytics following airway surgeries that require a period of postoperative sedation. 4 In an effort to address such variations, we codesigned a clinical pathway directing all aspects of postoperative management following all complex airway procedures at our institution. In this report we describe our protocol for postoperative sedation and critical care management following major airway reconstruction in children <5 years old.…”