Management of epiglottitis in children.

Because of our experience, as anesthesiologists, in the treatment of upper airway obstructions, we have been asked to see children with epiglottitis. Over a 5-year period, we have treated 28 such cases. Our hope that IPPB and nebulized racemic epinephrine would quickly relieve the obstruction, as it has in laryngotracheobronchitis, did not materialize. The obstruction from the edematous aryepiglottic folds and other hypopharyngeal structures was not relieved by such treatment, and half required an artificial airway, five by tracheal intubation. However, we documented two facts: (1) that the obstructed patient with epiglottitis can be ventilated and benefited by positive pressure by mouth or machine and that this ventilatory support can be life saving, rather than worsening the obstruction as was previously thought; (2) that with heavy-dose antibiotic-steroid therapy, the severe obstruction can be expected to improve significantly 8 to 12 hours after the onset of treatment. With this observation, we have extubated our patients at this time, rather than at 24 hours or later.