title: [Anesthetic management for laryngotracheal separation and tracheoesophageal diversion].
abstract: Patients with severe neurological impairment may develop recurrent pneumonia due to aspiration. Laryngotracheal separation and tracheoesophageal diversion are one of the surgical treatments to prevent salivaly aspiration. We report anesthetic management for laryngotracheal separation and tracheoesophageal diversion of five pediatric patients with severe cerebral palsy. Anesthetic problem was that all patients was repeating intractable pneumonia. And when the trachea was resected from esophageal mucosa, we experienced temporary ventilatory disturbance. So airway management was most important during anesthesia. Perioperative complications were postanesthetic seizure and postoperative brief apnea. Recurrent fever and aspiration pneumonia subsided in all of them. Our impression is that laryngotracheal separation and tracheoesophageal diversion are not so invasive surgical treatment for intractable pneumonia. But perioperative management should be concerned about both respiratory and neurological problems.
authors.affiliation: Department of Anesthesia, Kobe Children's Hospital, Kobe 654-0081.
authors.forename: Sayoko
authors.initials: S
authors.lastname: Takekida
authors.forename: Naoko
authors.initials: N
authors.lastname: Okada
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Kujime
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sakai
authors.forename: Makoto
authors.initials: M
authors.lastname: Shiga
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Obara
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D000768:Anesthesia, General; D001049:Apnea; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000150:complications; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D007830:Larynx / Q000601:surgery*; D019990:Perioperative Care; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D012640:Seizures; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome