Postoperative management of partial cricotracheal resection (PCTR) for subglottic stenosis with 15 cases in children

Abstract

In children with severe subglottic stenosis, decannulation of tracheostomy tube is desired. Laryngotracheal reconstruction, however, can lead to various severe complications: restenosis and potential for dehiscence. Partial cricotracheal resection (PCTR) is another method, but complications have also been reported. For that reason, we provide postoperative management in PICU to decrease complications. We assessed the postoperative management of 15 patients who underwent PCTR between July 2016 and June 2019. Median age at the time of surgery was 8 years old. We used sedative management with fentanyl, midazolam, and muscle relaxation by rocuronium in all patients. Dexmedetomidine supplementation was used for patients in whom sedation was difficult. Median ventilation duration was nine days, and the median length of PICU management was 12 days. All patients had full removal of tubes. Minor complications included mild atelectasis in six cases and suspected drug withdrawal symptoms or delirium in five cases. There was no unplanned extubation, restenosis, or anastomotic dehiscence. Absolute rest by sedation and careful postoperative management in PICU effectively avoided severe complications in children with severe subglottic stenosis.