Paediatric tracheostomy: an analysis of 40 cases

Abstract

Tracheostomy in the paediatric patient has been associated with significant morbidity and mortality compared to that in the adult. A retrospective analysis was made of 40 patients up to the age of 12 years having tracheostomies. Upper airway obstruction made up the commonest (32 patients, or 80 per cent) indication for paediatric tracheostomy in our series where males slightly outnumbered females. The majority (31 patients, or 77.5 per cent) underwent the operation under general anaesthesia with endotracheal intubation. Thirty-four (85 per cent) patients underwent ‘planned’ tracheostomies and six (15 per cent) underwent ‘crash’ procedures. Thirteen (32.5 per cent) patients were under the age of one year when tracheostomies were performed. The maximum duration of tracheostomies was between one week to within a month and after one month to within three months; each containing 11 (27.5 per cent) patients.Sixty-four different surgical procedures were performed on these patients in which laryngoscopy and bronchoscopy were the commonest procedures. Nine (22.5 per cent) had early post-operative and 14 (35 per cent) had late post-operative complications. Among these 40 children with tracheostomies, one (2.5 per cent) died due to a tracheostomy-related cause and 10 (25 per cent) due to the primary disease process itself. Tracheostomies performed to provide access for general anaesthesia for other surgical procedures were associated with a better prognosis.

Interfaces for long-term noninvasive positive pressure ventilation in children

“…While it has been used in children and adolescents suffering from these various disorders for many years, more recently it is also being used in younger patients and patients with various diseases associated to severe bilateral facial deformities, such as Goldenhar syndrome, Treacher Collins syndrome, achondroplasia, craniostenosis, and Down syndrome [1][2][3]. In these patients, NPPV represents an interesting noninvasive alternative to tracheostomy, which is associated with significant morbidity and may impair normal development and, particularly, language development [4,5]. Discomfort and disruption of social and family life are common consequences of patients with a tracheostomy.…”

Anesthetic experience of 100 pediatric tracheostomies

“…Previous studies on tracheostomy (3,10,15) only describe airway techniques involving endotracheal intubation and where this is not possible with the use of a rigid bronchoscope. Alternatively, in a study of 40 tracheostomies performed in children in Papua New Guinea, nine were performed under local anesthetics (16). Difficulty in intubation therefore should be expected, and a ‘plan B’ prepared prior to induction of anesthesia for tracheostomy.…”

Complications in paediatric airway management

“…The various complications that can occur following a tracheostomy in a paediatric patient are mentioned in Table 1 [17][18][19]. Apnoea may be a problem in children born with a low birth weight or an associated chronic lung disease.…”