AIRWAY COMPLICATION FOLLOWING BRONCOSCOPY AND TRACHEAL INTUBATION IN PEDIATRIC PATIENTS WITH COINCIDENTAL ASYMPTOMATIC SUBGLOTIC STENOSIS

Abstract

Introduction: The subglot is the most narrow part of the airway in children The most common cause of subglotic stenosis is due to trauma secondary to tracheal intubation. Many cases of subglotic stenosis are asymptomatic and discover only during an ordinary broncoscopy or tracheal intubation. Since the ordinary size broncoscope or tracheal tube can not be passed down the stenotic area, during broncoscopy or tracheal intubation in these patients the stenotic area of subglotic ring may be exposed to repeated mechanical trauma and postoperative airway obstruction which is the subject of the present research.
Methods: During a triennium, children escheduled for broncoscopy or tracheal intubation were investigated for the presence of subglotic stenosis and the development of postoperative airway obstruction. Frequency of postoperative airway problems were compared between the patients with and those without subglotic stenosis using Chi-Square method.
Results: Fourteen cases of subglotic stenosis were identified which all of them developed some forms of postoperative airway obstruction. Eighty six percent of these patient had a positive history for previous tracheal intubation. Nine patient out of 14 with subglotic stenosis required endotracheal intubation and seven of these patients underwent tracheostomy.Two patients died of accidental tracheal extubation.
Discussion: Broncoscopy and tracheal intubation in patients with asymptomatic subglotic stenosis is very dangerous and may lead to severe postoperative airway obstruction due to mechanical trauma of repeated broncoscopy or tracheal intubation. Therefore it is logical to manage the high risk patients (those with previous tracheal intubation) with extreme caution and preferably by an experienced physician.