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- Title
Újszülöttkori és csecsemőkori felső légúti szűkületek diagnosztikájának speciális szempontjai.
- Authors
Ilona, Szegesdi; Balázs, Sztanó; Ádám, Bach; Eszter, Erdélyi; Zsófia, Bere; Gábor, Horváth; Zita, Zákány; Péter, Gál; László, Rovó; Barna, Babik
- Abstract
Introduction: Examination and assessment of the upper airway of neonates and infants are difficult due to their anatomical properties and vulnerability. Tracheal intubation is impractical because it does not provide ideal conditions for the examination of functional diseases. In our study high-frequency jet ventilation (HFJV) was used for better visualization of the laryngeal and subglottic structures without intubation. Methods: In cooperation with University of Szeged Department of Pediatrics, in 2019 and 2020 we studied 40 infants coming from and outside of the region with airway compromise, predominantly inspiratory stridor. The study was carried out at the Department of Oto-Rhino-Laryngology and Head-Neck Surgery. Conduct of anaesthesia: After inhalational induction with sevoflurane and vein cannulation, total intravenous anaesthesia was maintained. We used assisted jet ventilation for gaining diagnosis. In cases of surgical intervention, the following drugs were administered: nalbuphin (0.1 mg/kg) or fentanyl (2 Mg/kg) from the age of 2 years; propofol (1 mg/kg), muscle relaxant if needed rocuronium (0.6 mg/kg). Settings of HFJV were IT: 20-30%; DP: 0,3-0,5 bar. Frequency: 150/cycle; PP: 10 cmH2O; PIP: 12 cmH2O. During laser surgery, maximal FiO2 was 30% instead of 40%. Results: In three cases the diagnosis was bilateral vocal cord paralysis and endoscopic arytenoid abduction lateropexy (EAAL) was carried out (the lateralizing instrument can only be introduced into the larynx without intubation). Extensive laryngeal papillomatosis observed in 2 children needed removal by laser and topical administration of Avastin. In 4 cases extensive subglottic and tracheal stenosis was found, so tracheal resection was performed under general anaesthesia with endotracheal intubation. 14 infants underwent laser microsurgery of the glottic space, aryepiglottoplasty because of severe laryngomalada. In 17 cases the diagnosis was tracheomalacy that did not require surgical intervention. Conclusions: We conclude that supraglottic jet ventilation is effective in diagnosing and evaluating functional and organic laryngeal and tracheal stenoses. Also, quick and simple surgical procedures can be performed safely with this technique.
- Publication
Hungarian Journal of Anesthesiolog & Intensive Therapy / Aneszteziológia és Intenzív Terápia, 2021, Vol 51, Issue 4, p21
- ISSN
0133-5405
- Publication type
Article