Short use of muscle relaxants following single stage laryngotracheoplasty in children.
OBJECTIVE
The postoperative management of children undergoing single stage laryngotracheoplasty (SSLTP) includes intubation and muscle paralysis to secure the airway and protect the wound. We reduced the period of postoperative muscle paralysis in an attempt to decrease the incidence of pulmonary complications. The objective of this study was to evaluate the influence of the duration of muscle paralysis on pulmonary complications and outcome.


METHODS
Medical records of all children admitted, between 1994 and 2002, to the pediatric intensive care unit following SSLTP were analysed. Children were grouped according to the number of days muscle paralysis was used.


RESULTS
Thirty-six children (15 male, 21 female, mean age 32 months (9-162 months)) underwent SSLTP for laryngeal stenosis. Prior to surgery 29 needed a tracheotomy (mean duration 11.1 months). Shorter muscle paralysis leads to shorter intubation and mechanical ventilation and therefore PICU and hospital length of stay were 12.4 and 9.9days shorter in the group with short use of muscle paralysis (p<0.001 and p=0.002, respectively). There was no significant difference in postoperative complications, but a trend towards fewer atelectases in children with short muscle paralysis could be recognised. Postoperatively we observed no auto-extubations in either group and success rate of SSLTP was comparable in both groups (94 and 95%).


CONCLUSIONS
Children undergoing SSLTP can safely benefit from a postoperative strategy using a short duration of muscle relaxants. They have fewer days on mechanical ventilation with a concomitant decrease in duration of hospital stay.
Roeleveld
P P
PP
Erasmus MC-Sophia Children's Hospital, Department of Pediatric Intensive Care, Dr. Molewaterplein 60, 3015 GJ Rotterdam, Netherlands. pproeleveld@hetnet.nl
Hoeve
L J
LJ
Joosten
K F M
KF
de Hoog
M
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome; D014673:Vecuronium Bromide / Q000008:administration & dosage*; D015300:Ventilator Weaning
D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide