International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Feb 1988
Case ReportsLacerations of the cervical trachea in children.
Two case histories of a posterior tracheal laceration in children are presented. Both lacerations were small and well approximated at the time of initial endoscopy, and were managed conservatively. The resolution of signs and symptoms was rapid, and both patients were discharged after 4 days of hospitalization. ⋯ When a tracheal laceration occurs, an immediate tracheostomy is usually recommended. Our experience supports a conservative management of small membraneous cervical trachea lacerations which seem well approximated at the time of endoscopy. Potential morbidity from tracheostomy is avoided, and the patient's hospitalization shortened.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 1987
Case ReportsAcquired subglottic cysts in premature infants.
Advances in the management of premature infants have resulted in improved survival. However, long-term intubation may produce associated laryngeal complications. We report 12 infants and children who developed subglottic cysts following long-term intubation as newborns. ⋯ An initial attempt of conservative management with endoscopic excision is made. If this fails, an anterior cricoid split may be indicated in cases where the cysts are associated with soft tissue subglottic stenosis. Tracheostomy may be unavoidable in some cases.
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The cricoid split operation is a well established treatment for subglottic stenosis; the success rate for this procedure is approximately 77%. The management of patients who fail this operation has traditionally involved tracheostomy followed by delayed laryngotracheoplasty. We have treated 22 patients using the cricoid split--6 required subsequent tracheostomy. ⋯ In contrast, 3 patients had repeat cricoid split operations instead of tracheostomy. All 3 of these children have had no further problems with their airway. The authors propose that in patients who fail the cricoid split operation one consider repeating the procedure instead of performing a tracheostomy.
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Int. J. Pediatr. Otorhinolaryngol. · Nov 1987
Comparative StudyThe effects of suctioning techniques on the distal tracheal mucosa in intubated low birth weight infants.
Microscopic pathology of the distal trachea at autopsy was retrospectively reviewed in 51 low birth weight infants (less than 1250 g). Twenty-six patients from 1977 who had nasal and/or orotracheal intubation and who underwent suctioning with uncontrolled deep suctioning technique were compared to 25 patients from 1980 who had orotracheal intubation with suctioning to the tube tip only. Clinical diagnoses, duration of intubation and number of intubations were correlated to degree of distal tracheal injury: absent (normal epithelium), mild (focal epithelial loss), moderate (diffuse epithelial loss/some inflammation), or severe (submucosal ulceration/squamous metaplasia). ⋯ The diagnoses of hyaline membrane disease, anemia, hyperbilirubinemia and coagulation disorder were seen more frequently in patients with moderate and severe tracheal pathology both in 1977 and 1980. Despite factors which should lead to greater tracheal injury--longer duration of intubation, lower birth weights and younger gestational age--less tracheal injury was seen in infants undergoing careful suctioning techniques. Clinical implications for the low birth weight neonate are discussed.
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Int. J. Pediatr. Otorhinolaryngol. · Nov 1987
Jet ventilation for laser laryngeal surgery in children. Modification of the Saunders jet ventilation technique.
In our clinical series, 40-50% O2 and 50-60% N2O (regulated by a blender and delivered by manual jet ventilation (MJV] and residual halothane from induction provided satisfactory supralaryngeal anesthesia. Fentanyl, N2O, atracurium, and lidocaine administered i.v. effectively blunted laryngeal stimulation, allowed control of respiration, and minimized vocal cord motion. Wide unobstructed surgical access to the entire endolarynx is provided. ⋯ We believe that the MJV technique is advantageous in children, particularly for outpatient surgery. Attention to detail and careful communication between a skilled anesthesiologist and surgeon are essential. Dangerous barotrauma can occur and skill and monitoring are essential.