Anesthetic management during tracheotomy in a child with respiratory distress caused by severe intubation-induced glottic stenosis.
We provided anesthetic management during a tracheotomy procedure for a child who demonstrated labored respiration during inspiration because of severe glottic stenosis and bilateral vocal cord paralysis caused by tracheal intubation. A 4-year-old boy developed acute respiratory depression associated with influenza pneumonia and had been under respiratory management with mechanical ventilation with tracheal intubation for 3 days. Following extubation, an upper-airway obstruction immediately appeared. The symptoms later worsened because of development of a common cold, and the patient underwent an emergency tracheotomy. For anesthetic management, we used a combination of ketamine with low-concentration sevoflurane inhalation. The tracheotomy was performed safely without respiratory complications by employing manual-assisted ventilation, while spontaneous breathing was preserved by use of a face mask.
Department of Anesthesiology, Osaka City General Hospital and Children's Hospital, Osaka, Japan. mami1030@gmail.com
Mami
M
Ueda
Ryu
R
Okutani
Kazuo
K
Nakada
Tomoaki
T
Nakano
Ayako
A
Kinoshita
D000758:Anesthesia / Q000379:methods*; D002675:Child, Preschool; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007829:Laryngostenosis / Q000150:complications*; D008297:Male; D014140:Tracheotomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000601:surgery*