DECREASING MORBIDITY FOLLOWING LARYNGOTRACHEAL RECONSTRUCTION IN CHILDREN

Our objectives are to report (1) methods for decreasing infectious com plications and excessive weakness associated with the period of sedati on and neuromuscular blockade (NMB) following single-stage laryngotrac heal reconstruction (SSLTR); (2) an association between gastroesophage al reflux (GER) and subglottic stenosis (SGS); (3) results of 21 SSLTR s and 1 two-stage LTRs (TSLTRs). A retrospective chart review was perf ormed for the period January, 1990-August, 1995, including 36 patients who had 38 LTRs for SGS and/or posterior glottic stenosis at a tertia ry care center. Our most recent post-SSLTR protocol included. (1) prop hylactic antimicrobials (clindamycin plus antipseudomonal agents = C A), (2) GER treatment, (3) titrated infusion NMB with daily recovery of neuromuscular function; (4) avoidance of prolonged simultaneous adm inistration of NMB and corticosteroids. Patients who had prophylactic antimicrobials (C + A) during intubation following SSLTR had fewer (1/ 13, 8%) postoperative infectious complications than patients who recei ved other/no antibiotics (4/8, 50%) (P < 0.05). Avoidance of prolonged simultaneous administration of NMB and corticosteroids and use of tit rated infusion of NMB with daily recovery of neuromuscular function wa s associated with less weakness following extubation (0/11, O% vs. 4/6 , 66%) (P < 0.002). Of 26 patients tested for GER, 21 (81%) had at lea st one positive test. suggesting a significant association between GER and SGS (P < 0.05), The overall success rate for LTR was 33/36 or 92% . SSLTR had a 95% success rate while two-stage LTR had an 87% success rate, although two revisions were required. Prophylactic antimicrobial s, improved postoperative management and GER treatment allowed success ful LTRs with decreased infectious complications and less weakness. (C ) 1997 Elsevier Science Ireland Ltd.