Prenatal Diagnosis and Management of Congenital Subglottic Stenosis Associated with Congenital Esophageal Atresia Type C

Sato, Tomoyuki; Nio, Masaki; Tanaka, Hiromu; Ohi, Ryoji

doi:10.1055/s-2007-965768

Cited by 1 publication

(3 citation statements)

References 7 publications

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“…Diagnosis of congenital high airway obstruction syndrome (CHAOS) is problematic (2). Antenatal ultrasound may reveal hyperechoic enlarged lungs, dilated trachea, flattened diaphragm, polyhydramnios and an apparently fluid filled esophagus (2).…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory difficulty soon after birth has many causes. When it is associated with no audible cry, stridor, marked respiratory effort, severe cyanosis and an inability to ventilate the lungs with bag mask an airway anomaly should be suspected (1,2). CHAOS is associated with normal larynx to level of the vocal cords, and little airway below this.…”

Section: Discussionmentioning

confidence: 99%

“…S ir— Subglottic stenosis is a very rare association with the tracheesophageal fistula and only a few cases have been reported in literature (1,2). We report the successful anesthetic management of Subglottic stenosis (SGS) complicating tracheesophageal fistula (TOF) in a newborn.…”

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confidence: 99%

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Anesthetic management of subglottic stenosis complicating tracheo‐esophageal fistula in a newborn

Shanbhag

Millar

2008

Pediatric Anesthesia

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In pediatric anesthesia practice, drug dosing is commonly scaled by body weight, although this relationship may often be imprecise. It is apparent that neonates and infants require much larger weight-scaled doses to achieve a similar dermatomal level compared with adults. Even with these larger weight-scaled doses, the duration of action may be only one-third as long (3). This was initially attributed to higher weight-scaled volume of cerebrospinal fluid in neonates and infants compared with older children and adults. Subsequently age related differences in pharmacodynamics and tissue barriers in addition to other factors were thought to play a role.Although the doses of fentanyl may be higher in children older than 1 year when compared with adults, it may be difficult to speculate this from our study. The dose of 0.2 lgAEkg )1 may be too small a dose to produce any significant improvement in pain scores. In fact in our study, doses as high as 0.5 lgAEkg )1 did not produce any clinically significant effect in infants. Tobias had described a postoperative case of neuroblastoma in a 22-month old child in which 0.5 lgAEkg )1 of IT fentanyl followed by continuous IT infusion of 0.2 lgAEkg )1 AEh )1 fentanyl was given for postoperative analgesia (4).In spite of the fact that circumcision is a minor procedure the pain can be severe and long-lasting. Apiliogullari et al. have mentioned a study which says IT fentanyl does not prolong the recovery of sensation to pinprick at the dermatome S2, however, sensory block in both the thoracic and the lumbar dermatomes is prolonged. In this study, lidocaine is used with IT fentanyl as opposed to hyperbaric bupivacaine in our study. It may not be possible to correlate both these local anesthetics. Even with the use of different doses of bupivacaine with 25 lg IT fentanyl, the motor and sensory block varies although the dose of fentanyl is kept constant (5). Spinal motor block resolves much faster than sensory block, but the feasibility of short procedures in low dermathomeric sites gives no information regarding longer and higher surgical procedures. The lack of constants in collected information on sensory-block regression levels still make data regarding duration inaccurate (6). Penile block was not used in our study! References1 Hunt CO, Naulty JS, Bader AM et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989; 71: 535-540. 2 Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg 1992; 74: 653-657. 3 Abajian JC, Mellish RW, Browne AF et al. Spinal anesthesia for surgery in the high-risk infant. Pitkänen MT et al. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%