Postoperative medical management in single-stage laryngotracheoplasty.

OBJECTIVE

To determine whether it is safe and effective to avoid the use of neuromuscular relaxants in patients who have indwelling nasotracheal tubes after undergoing single-stage laryngotracheoplasty.

DESIGN

Retrospective case series.

SETTING

University-based referral center specializing in the surgical management of laryngotracheal stenosis and other pathologic conditions of the airway.

PATIENTS

Referred sample of 104 consecutive patients (67 males, 37 females) undergoing single-stage laryngotracheoplasty for subglottic stenosis.

INTERVENTION

Single-stage laryngotracheoplasty.

MAIN OUTCOME MEASURES

Incidence of accidental extubation, use of neuromuscular relaxants, incidence of reintubation after planned extubation, duration of intubation, overall rate of successful airway expansion.

RESULTS

One patient self-extubated without sequelae. One patient required a brief course of neuromuscular relaxants. The success rate (without further laryngotracheoplasty) for all patients was 86% (89/104). For the 25 patients operated on in 1992, with at least 1 year of follow-up, the success rate was 92% (23/25).

CONCLUSION

Single-stage laryngotracheoplasty can be done safely and effectively without using paralyzing agents in the postoperative period. This approach has certain advantages, which are discussed.