Perioperative airway management of infantile subglottic hemangioma

Abstract

Objective:To investigate the relevant influencing factors for perioperative airway events of infantile subglottic hemangioma, and to further discuss the strategies of perioperative airway management. Methods:A total of 36 infants with subglottic hemangioma that had no response to the drug therapy and underwent surgical treatment from July 2007 to April 2017 were enrolled. The relevant influencing factors, including gender, age, birth weight, age of onset, degree of tracheal stenosis and histories of underlying diseases（congenital heart disease and respiratory disease）, were also recorded simultaneously. Intraoperative SpO₂ decline, intraoperative emergency tracheal intubation, intraoperative emergency tracheotomy, whether preserving tracheal intubation after operation or not, and postoperative emergency tracheal intubation were included in the perioperative airway events of infantile subglottic hemangioma. The relevant influencing factors of perioperative airway events were analyzed so that meaningful statistical indicators were selected for grouped logistic regression analysis, and the correlation was evaluated based on OR value and 95% confidence interval（CI）. Based on the correlation between influencing factors and airway events, perioperative airway management was discussed. Results:①The degree of tracheal stenosis was a risk factor for SpO₂ decline（95%CI[2.121-33.818]）; ②The degree of airway stenosis, history of comorbid cardiovascular disease and respiratory disease were the influencing factors for intraoperative emergency tracheal intubation（95%CI[0.863-21.692], [0-+∞] and [1.741-232.403], respectively）; ③The degree of airway stenosis was the influencing factor for postoperative emergency tracheal intubation（95%CI[1.277-20.421]）; ④The degree of airway stenosis was a risk factor for whether preserving postoperative tracheal intubation or not（95%CI[1.523-13.296]）. Conclusion:①Infants with a history of preoperative underlying diseases are more likely to present with intraoperative airway instability and SpO₂ decline, which deserves more preoperative and postoperative attention. Tracheal intubation should be performed timely in case of intraoperative SpO₂ decline. ②Preoperative tracheotomy should be performed in infants with preoperative grade Ⅲ airway stenosis, especially those with comorbid heart diseases or respiratory diseases. ③The degree of airway stenosis is an extremely important influencing factor for perioperative airway management of infantile subglottic hemangioma. For infants whose airway stenosis were greater than 60% of airway diameter, the airway maintenance should be closely monitored. Once SpO₂ decreases, tracheal intubation should be performed immediately. It's recommended to preserve tracheal intubation so as to ensure the airway stability. The tracheal intubation could be prolonged to 48-72 hours postoperatively. ④The surgical approach has no significant effect on perioperative airway management.