DIAGNOSTIC BRONCHOSCOPY FOR EVALUATION OF CONGENITAL STRIDOR:A CASE SERIESJournal: International Journal of Advanced Research (Vol.9, No. 12)
Publication Date: 2021-12-14
Authors : Hina Khurshid Chandrika Y.R; Madhavi N;
Page : 318-325
Keywords : Stridor Laryngomalacia Bronchoscopy;
Introduction: Stridor is a noise mechanically produced through partially occluded airway. Airway obstruction may be extrathoracic or intrathoracic. Stridor may be congenital or acquired. Timing in respiratory cycle determines anatomic location of lesion Â– inspiratory, biphasic, or expiratory. Gold standard for diagnosis is bronchoscopy which requires general anaesthesia in infants and small children. Major anaesthetic concerns are Â– possible difficult airway, sharing of an already compromised airway, airway oedema. Case Description: 40 infants, 0 - 6 months age, with history of noisy breathing suggestive of congenital stridor, planned for diagnostic rigid bronchoscopy with or without therapeutic procedure, over one year period. Preoperative treatment Â– humidified oxygen, nebulization, dexamethasone, antibiotics, anti-reflux medication. Not premedicated, standard monitors applied. Induction of anaesthesia with inhalational oxygen and sevoflurane or intravenous propofol, fentanyl 1 mcg/kg, dexamethasone 0.5 mg/kg. Topical lidocaine 2% sprayed at vocal cords. 100% oxygen with propofol infusion for maintenance with spontaneous ventilation via nasopharyngeal airway. Patients requiring surgical intervention intubated using microcuffed endotracheal tube. Patients observed post-operatively. If ventilation was inadequate, intubated to control airway during recovery, extubated on restoration of spontaneous ventilation. After surgical intervention, babies shifted to ICU for elective ventilation for 48 hours. Discussion: On bronchoscopy, laryngomalacia was the finding in majority of cases. Others had subglottic stenosis, tracheomalacia, vocal-cord paresis, laryngeal cyst. Out of 40 patients, 9 underwent therapeutic procedure and were electively ventilated, 26 resumed spontaneous breathing, 2 patients had delayed recovery and 2 had severe chest retractions and desaturations and they were managed accordingly. One baby aged 6 months diagnosed with grade III subglottic stenosis desaturatedand tracheostomy had to be done. Conclusion:Anaesthesia for rigid diagnostic bronchoscopy is a significant challenge. Rigid bronchoscopy under general anaesthesia requires multidisciplinary approach and close cooperation between all team members.
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