SEVERE COMPLICATIONS OF THE ANTERIOR CRICOID SPLIT OPERATION AND SINGLE-STAGE LARYNGOTRACHEOPLASTY

The management of congenital and acquired subglottic stenosis has been considerably facilitated with the introduction of the anterior cricoi d split operation and, more recently, the single-stage laryngotracheop lasty. These procedures are followed by a 1- to 2-week period of sedat ion, during which the patient is paralyzed and completely dependent on mechanical ventilation. Although these procedures have proven very su ccessful at achieving decannulation, the postoperative period can be t he source of significant complications. This is illustrated with 4 cas es of severe postoperative complications. The possible pathophysiologi c causes are discussed, and the literature concerning the postoperativ e complications of these procedures is reviewed. The avoidance of neur omuscular blockade must be weighed against the possible increased need for narcotics and increased risk of self-extubation. An intensive car e unit setting proficient in the care of these patients is necessary f or a successful outcome.