A rare and challenging case of anaesthetic management of paediatric laryngo-tracheo-broncho-malacia for supraglottoplasty

Parin Lalwani; Babita Gupta

doi:10.18203/2320-6012.ijrms20232453

Authors

Parin Lalwani Department of Anaesthesiology, AIIMS, New Delhi, India
Babita Gupta Department of Anaesthesiology, JPN Apex Trauma Center, AIIMS, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232453

Keywords:

Pediatric, Laryngotraceobronchomalacia, Airway collapse, Airway tone

Abstract

Paediatric laryngotracheobronchomalacia is a rare and extremely challenging scenario with risk of complete airway collapse under general anaesthesia. Laryngomalacia causes collapse of the supralaryngeal structures during inspiration as it is associated with short aryepiglottic folds, redundant arytenoid mucosa prolapsing into the glottis and a long curled epiglottis. Tracheomalacia and tracheo-bronchomalacia are characterized by abnormally compliant trachea and major bronchi. Most of the general anaesthetic agents decreases the airway tone and may predispose these patients to unremmitable airway obstruction under anaesthesia. We report successful anaesthetic management of one-year-old child with laryngotracheobronhcomalacia posted for supraglotoplasty. This needs a profound understanding of the pathophysiology of the complex airway condition and the effects of various anaesthetic agents on airway.

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References

Kusak B, Jars EC, Wasowicz UJ, Lis G. Types of laryngomalacia in children: interrelationship between clinical course and comorbid conditions. Eur Arch Otorhinolaryngol. 2017;274:1577-83.

Bruce IA, Rothera MP. Upper airway obstruction in children. Review article. Pediatric Anesthesia. 2009;19(S1):88-99.

Asai T, Shingu K. Airway obstruction in a child with asymptomatic tracheobronchomalacia. Can J Anaesth. 2001;48:684-7.

Eastwood PR, Szollosi I, Platt PR, Hillman DR. Collapsibility of the Upper Airway during Anesthesia with Isoflurane. Anesthesiology. 2002;97:786-93.

Hillman DR, Walsh JH, Maddison KJ, Platt PR, Kirkness JP, Noffsinger WJ. Evolution of Changes in Upper Airway Collapsibility during Slow Induction of Anesthesia with Propofol. Anesthesiology. 2009;111:63-71.

Zaben KA, Qudaisat I, Barazangi BA, Badran I. Use of dexmedetomidine as the main anesthetic agent in patients with laryngo-tracheomalacia. Middle East J Anaesthesiol. 2010;20:603-6.

Laschat M, Kaufmann J, Wappler F. Laryngomalacia with Epiglottic Prolapse Obscuring the Laryngeal Inlet. Anesthesiology. 2016;125:2.

Yano T, Taniguchi M, Tsuneyoshi I. Continuous rocuronium administration for tracheomalacia. J Anesth. 2015;29(6):978.

Okuda Y, Sato H, Kitajima T, Asai T. Airway obstruction during general anaesthesia in a child with congenital tracheomalacia. Eur J Anaesthesiol. 2000;17(10):642-44.