Continuous Muscle Relaxant Administration for the Management of Severe Tracheomalacia

Takeshi Yano

doi:10.24983/scitemed.acri.2018.00087

Abstract

Management of children with severe tracheomalacia is very difficult. Most cases require mechanical ventilation; the mortality rate from severe tracheomalacia is as high as 80%. Crying is often triggered, the respiratory condition gets worse, and eventually, it leads to death. For severe cases, surgical treatment should be considered immediately. Meanwhile, the prevention of fatal attacks by medical treatment is indispensable while waiting for surgery. In this report, a method to manage the patients with severe tracheomalacia using muscle relaxant was discussed. Based on clinical experience, continuous administration of 7 μg/kg/min of rocuronium was required to prevent life-threatening cyanotic attacks. However, the infusion requirements of rocuronium would show patient-to-patient variability. Further, case reports and evaluation of the effectiveness of muscle relaxants for the treatment of severe tracheomalacia were required.

Highlights

Management of children with severe tracheomalacia is very difficult
Tracheomalacia is a congenital malformation of the tracheobronchial cartilage that leads to the collapse of the airway and expiratory flow obstruction
Severe cases are rare and usually detected in the neonatal period when children present with acute severe obstructive episodes that can be associated with life-threatening cyanotic attacks [1]

Summary

Introduction

Management of children with severe tracheomalacia is very difficult. Most cases require mechanical ventilation; the mortality rate from severe tracheomalacia is as high as 80%. Severe obstructive episodes were reported with patients who had been managed by positive pressure ventilation, even during general anesthesia [4]. Tracheostomy or surgical treatments may be useful in tracheomalacia patients who present with life-threatening symptoms [2]. That report described the incidences of life-threatening hypoxemia due to tracheomalacia that were repressed by the continuous intravascular administration of rocuronium.

Results

Conclusion