POSTOPERATIVE CARE FOLLOWING SINGLE-STAGE LARYNGOTRACHEOPLASTY

Single-stage laryngotracheoplasty (SSLTP) provides a method of correct ing mild-to-moderate laryngotracheal stenosis while avoiding the risks of prolonged laryngeal stenting. pediatric patients are orally intuba ted for 5 to 7 days postoperatively to ensure an adequate airway while edema resolves and healing begins. During this period, continuous neu romuscular blockade has been advocated in infants and young children t o avoid endotracheal tube trauma to the fresh graft and potentially li fe-threatening accidental decannulation. Pulmonary atelectasis is the most common morbidity associated with prolonged neuromuscular blockade . Neuromuscular weakness also may follow prolonged paralysis and prolo ng hospitalization. This paper compares the postoperative course of 17 patients who underwent 18 SSLTP procedures by the senior author. The first 8 patients received continuous neuromuscular blockade in the ear ly postoperative period. To reduce perceived morbidity, the last 9 pat ients were managed with a protocol that incorporated daily 4- to 8-hou r ''interruptions'' of paralysis. Seven patients tolerated this protoc ol modification. As a group, these patients had less postoperative pul monary atelectasis prior to extubation (p < .05) and were extubated so oner than patients receiving continuous neuromuscular blockade (p < .0 5) without compromising the surgical success of the procedure. Intermi ttent paralysis permitted for more accurate assessment of pain control and protected against accidental drug accumulation. Although self-ext ubation did not occur, diligent nursing care with adequate sedation an d analgesia is necessary to avoid the risk of accidental extubation.