Short use of muscle relaxants following single stage laryngotracheoplasty in children

Roeleveld, Peter P.; Hoeve, L.J.; Joosten, K.F.; Hoog, Matthijs de

doi:10.1016/j.ijporl.2005.01.006

Cited by 6 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 For example, decreased postoperative paralytic use has been shown to decrease complications and hospitalization lengths after single-stage laryngotracheoplasty. 3,26 Younger age was also independently correlated with an increase in hospital stay after extubation. To our knowledge, no prior studies have specifically examined this relationship.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Dexmedetomidine as a Primary Sedative Agent after Single‐Stage Airway Reconstruction

McCormick

Johnson

Peña

et al. 2013

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

The use of dexmedetomidine as a primary sedation agent after single-stage airway surgery does not appear to improve outcomes or decrease the need for additional pharmacologic agents. Polypharmacy was associated with an increase in overall complications and an increased length of stay after extubation. Although success can be expected in greater than 90% of these surgical patients, the optimal postoperative sedation management remains challenging.

show abstract

Section: Discussionmentioning

confidence: 95%

“…Another explanation could lie in the known side effects and complications of certain individual agents 25 . For example, decreased postoperative paralytic use has been shown to decrease complications and hospitalization lengths after single‐stage laryngotracheoplasty 3,26 …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as a Primary Sedative Agent after Single‐Stage Airway Reconstruction

McCormick

Johnson

Peña

et al. 2013

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…1,5 Shorter use of muscle paralysis also decreases time to decannulation, length of ICU stay, and length of hospital stay. 5,18 Intermittent use of NMB and a rotating pharmacy regimen have demonstrated less atelectasis and a more rapid time to extubation. 1,18,19 In this study we found this approach to be useful in assisting proper extubation time in the postprotocol group.…”

Section: Discussionmentioning

confidence: 99%

“…5,18 Intermittent use of NMB and a rotating pharmacy regimen have demonstrated less atelectasis and a more rapid time to extubation. 1,18,19 In this study we found this approach to be useful in assisting proper extubation time in the postprotocol group. All standardized patients received at least 24 hours of NMB, and NMB holidays were started after the first 24 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Using a Postoperative Protocol in Pediatric Single-Stage Laryngotracheal Reconstruction

Thottam

Gilliland

Ettinger

et al. 2019

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objectives: The aim of this study was to evaluate single-stage laryngotracheal reconstruction (ssLTR) outcomes before and after the implementation of a postoperative care protocol in pediatric patients. Methods: A case-control study with chart review was conducted at 2 tertiary academic centers from 2010 to 2016. Pediatric patients who underwent ssLTR with a postoperative care protocol were compared with those who did not receive care under this protocol. Data regarding perioperative management were collected and compared using χ2 and Wilcoxon rank tests. Planned extubation, length of intubation in the intensive care unit, and complications were examined. Results: Nineteen patients completed ssLTR after the protocol was initiated, and 26 prior patients were used as control subjects. Planned extubation failed in 9 patients (35%) in the control group compared with 1 patient (5%) in the protocol group ( P < .05). Using a structured protocol demonstrated a decrease in delayed extubation and intensive care unit stay ( P < .05). Despite more postprotocol patients’ requiring posterior graft placement, preprotocol patients were less likely to be extubated within 7 days ( P < .05). Conclusions: The authors propose an intensive care unit protocol that uses a combination of pharmacologic agents to optimally reduce the risk for adverse events that delay time to extubation and thus decannulation. Timely extubation was more likely with the use of this postoperative care protocol using a multidisciplinary approach involving otolaryngologists, pharmacists, intensivists, and anesthesiologists.

show abstract

“…6 Perioperative management involving a multidisciplinary team is vital to the success of airway reconstruction. [7][8][9][10][11][12] During the postoperative period in the pediatric intensive care unit (PICU), the patient is usually nasotracheally intubated, requiring sedation and analgesia with or without neuromuscular blockade. The physical and pharmacologic precautions minimize excessive neck movement that could place tension on the newly repaired airway and decrease movement of the endotracheal tube that could disrupt suture lines and cartilage grafts, cause repeated trauma to the airway mucosa, or result in accidental extubation.…”

mentioning

confidence: 99%

Systemwide Change of Sedation Wean Protocol Following Pediatric Laryngotracheal Reconstruction

Kozin

Cummings

Rogers

et al. 2015

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Importance Pediatric laryngotracheal reconstruction (LTR) remains the standard surgical technique for expanding a stenotic airway and necessitates a multidisciplinary team. Sedation wean following LTR is a critical component of perioperative care. We identified variation and communications deficiencies with our sedation wean practice and describe our experience implementing a standardized sedation wean protocol. Objective Standardize and decrease length of sedation wean in pediatric patients undergoing LTR. Design Using Institute for Healthcare Improvement (IHI) methodology, we implemented system-wide change with the goal of improving care based on best practice guidelines. We created a standardized electronic sedation wean communication document and retrospectively examined our experience in 29 consecutive patients who underwent LTR before (n=16, pre-wean group) and after (n=13, post-wean group) wean document implementation. Setting Tertiary care center Participants Pediatric patients undergoing LTR Intervention Implement standardized sedation protocol Main Outcomes Presence of sedation wean document in electronic medical record, length of sedation wean, and need for continued wean after discharge Results The sedation wean document was utilized in 92.3% patients of the post-wean group. With the new process, the mean length of sedation wean was reduced from 16.19 (standard deviation [SD] 11.56) days in pre-wean group to 8.92 (SD 3.37) days in the post-wean group, p<0.05. Fewer patients in the post-wean group required continued wean after discharge, 81.3% vs. 33.3%, p<0.05. Conclusions and Relevance We implemented system-wide process change with the goal of improving care based on best practice guidelines, which significantly decreased the time required for sedation wean following LTR. Our methodological approach may have implications for other heterogeneous patient populations requiring a sedation wean.

show abstract

Short use of muscle relaxants following single stage laryngotracheoplasty in children

Cited by 6 publications

References 27 publications

Dexmedetomidine as a Primary Sedative Agent after Single‐Stage Airway Reconstruction

Dexmedetomidine as a Primary Sedative Agent after Single‐Stage Airway Reconstruction

Outcomes Using a Postoperative Protocol in Pediatric Single-Stage Laryngotracheal Reconstruction

Systemwide Change of Sedation Wean Protocol Following Pediatric Laryngotracheal Reconstruction

Contact Info

Product

Resources

About