Anesthesia for patients with subglottic cysts

Abstract

Key Clinical MessageAcquired subglottic cysts can cause rapid development of respiratory distress. Subglottic cysts are a disease of premature infants and other pathologies of prematurity should be anticipated. Perioperative success is dependent on communication between surgeon and anesthesiologist. Contingency plans for an emergency surgical airway should be in place in the event of total airway obstruction.

Congenital subglottic cyst: a rare cause for sudden airway compromise in a newborn

“…The risk of sudden and severe airway obstruction highlights the need for a prompt diagnosis and management plan coordinated by experienced ENT surgical and anaesthetic teams. 11 …”

“…Clear communication, role allocation and an agreed stepwise plan to manage the shared airway, including the need for an emergency tracheostomy in the event of an evolving ‘can’t intubate, can’t oxygenate’ scenario, are paramount. The risk of sudden and severe airway obstruction highlights the need for a prompt diagnosis and management plan coordinated by experienced ENT surgical and anaesthetic teams 11…”

The Clinical Features and Risk Factors of Subglottic Cysts in Children: A Clinical Experience Using the Spontaneous Respiration Technique

“…According to studies published to date, temporary tracheostomy was performed in 14%–33% of patients with SGCs [ 3 , 6 , 16 , 25 - 27 ]. In some cases, tracheostomies were performed before establishing a diagnosis due to worsening dyspnea, but most were temporarily performed when the SGC obstructed the glottis, rendering tracheal intubation difficult or when the cyst obstructed access to the surgical field [ 28 ]. The STRIVE Hi anesthesia technique may be useful for avoiding temporary tracheostomy in order to achieve effective marsupialization of SGC, since it can maintain proper oxygen saturation and thus can overcome the short apnea time in children.…”

Acquired subglottic cysts in children: A rare and challenging clinical entity. A systematic review

“…Spontaneous breathing anesthesia is of crucial importance to facilitate the surgical procedure. After the injection of IV systemic anesthetics, the topical use of lidocaine on the vocal cords under laryngoscopic guidance can reduce the risk of laryngospasm [31]. However, the possibility of an emergency tracheostomy has to be taken into account in all cases as the pediatric airway is very sensitive to manipulation and a sudden stenosis of the upper airway can occur.…”