Study on tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser combined with argon plasma coagulation and cryotherapy through bronchoscopy

Abstract

Objective To explore the operating methods, the effectiveness and safety for 2 cases of tracheal intubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interventional treatment. Methods Two male patients (age at 4 and 11 months)both had difficulty breathing and weaning failure after endotracheal intubation, who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination.All parents signed their consent after being fully informed of treatment risks.Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and freezing treatment by using the laryngeal mask.The clinical data, complications and postoperative outcome and follow-up were analyzed. Results Two cases were operated successfully, the subglottic granulation tissue of 1 case was completely removed, 2 cases of patients had subglottic narrow annular completely removed, and there was no problem for 4.0 mm bronchoscope to get through, postoperative tracheal catheter was successfully extracted, dyspnea was significantly improved.Two cases immediately showed well open after treatment, 7 d, 30 d and 90 d through endoscopic examination.During the operation, oxygen saturation decreased and heart rate increased fast or slowed down, but after operation and oxygen got resumed, they immediately recovered, and there were no abnormal hemodynamic changes during and after operation.The two cases were still under follow-up. Conclusions The laryngeal mask holmium laser, argon plasma coagulation and cryotherapy can be used to remove acquired granulation tissue hyperplasia caused by subglottic stenosis, which is safe and effective, and the short-term effect was remarkable.Long-term effect still needs to be further assessed through follow-up. Key words: Subglottic stenosis; Laryngealmask; Bronchoscop; Holmiumlaser; Argon plasma coagulation; Cryotherapy; Child