Blair Fearon

Surgical correction of subglottic stenosis of the larynx in infants and children. Progress report.

A survey of 25 consecutive cases of severe subglottic stenosis in children and infants, managed conservatively, revealed an unexpectedly high 24% mortality rate. A three year ongoing experimental study in infant primates indicated the feasibility of operative correction of subglottic stenosis without interference with usual laryngeal growth potentials. Initial results in the surgical correction of subglottic stenosis in two patients are very encouraging. For surgical correction of subglottic stenosis we recommend division of the cricoid and upper trachea anteriorly with interposition of autogenous cartilage, without removal of scar tissue, and without internal laryngeal stenting.

The Management of Long Term Airway Problems in Infants and Children

In the brief time allotted, this subject material cannot be presented in detail but an attempt will be made to select the more important conditions and features of long term airway problems in infants and children. No world shattering developments will be described, but because of many requests for information . regarding the management of these problems in children, especially that of subglottic stenosis, we felt it worthwhile to record our experience in treating such patients at the Hospital for Sick Children over the past 20 years.

LXXXI Airway Problems in Children following Prolonged Endotracheal Intubation

Trauma to the larynx from the use of various types of endotracheal tubes has been recognized virtually since MacEwen introduced a tube into the trachea via the mouth in 1880. Regrettably perhaps, in recent years, general anesthesia via the endotracheal route has almost completely supplanted open insufflation anesthesia in many centers. More recently, the use of endotracheal tubes has been broadened to encompass other clinical situations. The prolonged use of endotracheal intubation is now being advocated for postoperative respiratory depression requiring assisted ventilation (the depression not infrequently being a reaction to the drug or drugs used in the anesthesia) ; acute respiratory problems such as asthma, laryngotracheitis, idiopathic respiratory distress syndrome; central nervous system lesions such as meningitis, encephalitis, head injuries, etc.; as well as other medical conditions where there is a respiratory insufficiency.

Subglottic stenosis of the larynx in the infant and child. Methods of management.

This presentation is a ten-year retrospective study on all patients with proven subglottic stenosis admitted to the Department of Otolaryngology, Hospital for Sick Children, Toronto. Some of these patients have required no treatment, others one or two dilatations of the stenosis only; others tracheotomy only; some tracheotomy plus dilatations; some the Fearon-Cotton operation, and a few who had very extensive stenosis of the larynx and trachea, extensive reparative surgery. In this presentation, the authors describe the different types of management, and the results of treatment are assessed and compared.

Esophageal Perforation during Esophagoscopy in Children

Traumatic perforation of the esophagus during esophagoscopy is an ever present danger that can have long lasting or lethal effects. All are agreed on the need for early diagnosis. The question is often asked whether treatment should be nonoperative or operative. The results of management in this series of 21 patients support the opinions of those who advocate early adequate drainage of the mediastinum by means of mediastinotomy or thoracotomy, with support by antibiotic therapy, nothing by mouth and careful observation, if a large perforation is present. In minor perforations conservative treatment alone may suffice but should be accompanied by alert clinical observation.

Bronchoscopy in the treatment of severe acute bronchiolitis in children.

Acute bronchiolitis is a clinical syndrome most commonly seen in young infants: The signs and symptoms are primarily due to obstruction of the infants tiny bronchioles by inflammatory edema of the mucosa, sticky, tenacious secretions within the lumen and a superimposed element of bronchospasm. The resultant partial obstruction leads to poor air entry and obstructive emphysema. Areas of collapse may occur if bronchiolar obstruction becomes complete. Death may result from anoxemia or pulmonale.

LXXXI AIRWAY PROBLEMS IN CHILDREN FOLLOWING PROLONGED ENDOTRACHEAL INTUBATION

ologists, which has been published elsewhere, will be presented. Primarily the material will contain fundamental basic informatwn which has been presented by aneatheswlogists, physiologists, pharmacologists, and others and, on m w n , by commercial firm. In the last instance, these reprintings are not to be construed as an endorsement of the particular commercial firm or its product by Aneathesia and Analgesia-Current Researches. In each issue of the Journal an article of pcuticulur interest and value to anesthesi-