Kumar Arun, Singh Shrawin Kumar, Agrawal Vineet
Department of Anaesthesiology, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
Department of ENT, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
Saudi J Anaesth. 2017 Jan-Mar;11(1):99-101. doi: 10.4103/1658-354X.197336.
Subglottic stenosis is a known complication of a traumatic and prolonged intubation. In a child, subglottic area is narrower and more prone to damage by an oversized or overinflated endotracheal tube. The stenosis can present with complaints of change in voice, croup, or respiratory obstruction. Those presenting with respiratory obstruction require immediate diagnosis under direct laryngoscopy and timely corrective intervention under general anesthesia. A 4-year-old child came to the emergency department with severe respiratory obstruction. His medical history revealed invasive ventilatory management for aspiration pneumonitis 2 months back. Under direct laryngoscopy, we found severe narrowing of the subglottic area due to subglottic web. Since the subglottic area was so stenosed, intubation was impossible. Hence, emergency tracheostomy was performed to secure patient airway, followed by microlaryngeal surgery to remove the subglottic web. Acquired subglottic stenosis in a child can be a life-threatening situation which requires immediate airway management. It should be suspected in any child in severe respiratory obstruction with a history of prolonged intubation.
声门下狭窄是创伤性和长时间插管的一种已知并发症。对于儿童而言，声门下区域较窄，更容易因气管内导管尺寸过大或充气过度而受损。狭窄可能表现为声音改变、哮吼或呼吸阻塞等症状。那些出现呼吸阻塞的患者需要在直接喉镜检查下立即诊断，并在全身麻醉下及时进行纠正干预。一名4岁儿童因严重呼吸阻塞来到急诊科。他的病史显示2个月前因吸入性肺炎接受了有创通气管理。在直接喉镜检查下，我们发现由于声门下蹼导致声门下区域严重狭窄。由于声门下区域狭窄严重，无法进行插管。因此，进行了紧急气管切开术以确保患者气道安全，随后进行了显微喉手术以切除声门下蹼。儿童获得性声门下狭窄可能是一种危及生命的情况，需要立即进行气道管理。对于任何有长时间插管史且出现严重呼吸阻塞的儿童，都应怀疑有此病。
