Abstract
A patients with congenital tracheal stenosis (CTS) require long-term mechanical ventilation, and have many difficult airway problems, such as tracheal bleeding, granulomatous formation, etc. The ultimate aim is succeed in extubation against the challenges of respiratory complications. We have managed six pediatric CTS patients in our Intensive Care Unit during the past six years. A postoperative 3-stage management period has been used in these cases.
In the first stage, patients are paralyzed and sedated using benzodiazepines and neuromuscular blocking agents to stabilize tracheal anastomosis until 10 days after operation. This is to prevent postoperative tracheal bleeding due to insufficient sedation and neuromuscular blockade in these period.
In the second stage, for patient stability, we have preferred the administration of isoflurane and morphine instead of neuromuscular blocking agents. Aggressive pulmonary physical therapy, and diagnostic and therapeutic bronchoscopies have also been performed as needed.
In the third stage, weaning from mechanical ventilation is performed. For the prevention of excessive respiratory effort, we have administered a variety of sedative drugs, such as midazolam, promethazine. Further research, however, is required to improve management procedures after the extubation.
