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Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques

Published online by Cambridge University Press:  12 April 2019

E J Damrose*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, California, USA
L Manson
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, California, USA
V Nekhendzy
Affiliation:
Department of Anesthesiology, Stanford University Medical Center, California, USA
J Collins
Affiliation:
Department of Anesthesiology, Stanford University Medical Center, California, USA
R Campbell
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, California, USA
*
Author for correspondence: Dr Edward J Damrose, Department of Otolaryngology, Head and Neck Surgery, 801 Welch Road, Stanford, CA 94305, USA E-mail: [email protected] Fax: +1 650 725 8502

Abstract

Objective

To describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.

Methods

The medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.

Results

Objective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.

Conclusion

Laryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr E J Damrose takes responsibility for the integrity of the content of the paper

References

1Damrose, EJ. On the development of idiopathic subglottic stenosis. Med Hypotheses 2008;71:122–5Google Scholar
2Mark, EJ, Meng, F, Kradin, RL, Mathisen, DJ, Matsubara, O. Idiopathic tracheal stenosis: a clinicopathologic study of 63 cases and comparison of the pathology with chondromalacia. Am J Surg Pathol 2008;32:1138–43Google Scholar
3Poetker, DM, Ettema, SL, Blumin, JH, Toohill, RJ, Merati, AL. Association of airway abnormalities and risk factors in 37 subglottic stenosis patients. Otolaryngol Head Neck Surg 2006;135:434–7Google Scholar
4Valdez, TA, Shapshay, SM. Idiopathic subglottic stenosis revisited. Ann Otol Rhinol Laryngol 2002;111:690–5Google Scholar
5George, M, Lang, F, Pasche, P, Monnier, P. Surgical management of laryngotracheal stenosis in adults. Eur Arch Otorhinolaryngol 2005;262:609–15Google Scholar
6Giudice, M, Piazza, C, Foccoli, P, Toninelli, C, Cavaliere, S, Peretti, G. Idiopathic subglottic stenosis: management by endoscopic and open-neck surgery in a series of 30 patients. Eur Arch Otorhinolaryngol 2003;260:235–8Google Scholar
7Krimsky, WS, Rodrigues, MP, Malayaman, N, Sarkar, S. Spray cryotherapy for the treatment of glottic and subglottic stenosis. Laryngoscope 2010;120:473–7Google Scholar
8Lee, K-H, Ko, G-Y, Song, H-Y, Shim, TS, Kim, WS. Benign tracheobronchial stenoses: long-term clinical experience with balloon dilation. J Vasc Interv Radiol 2002;13:909–14Google Scholar
9Roediger, FC, Orloff, LA, Courey, MS. Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 2008;118:1542–6Google Scholar
10Smith, ME, Elstad, M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope 2009;119:272–83Google Scholar
11Mazze, RI, Kallén, B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989;161:1178–85Google Scholar
12Scholz, A, Srinivas, K, Stacey, M, Clyburn, P. Subglottic stenosis in pregnancy. Br J Anaesth 2008;100:385–8Google Scholar
13Kuczkowski, KM. Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv 2004;59:52–6Google Scholar
14Sutcliffe, N, Remington, SA, Ramsay, TM, Mason, C. Severe tracheal stenosis and operative delivery. Anaesthesia 1995;50:26–9Google Scholar
15Paré, P, Donevan, R, Nelems, J. Clues to unrecognized upper airway obstruction. Can Med Assoc J 1982;127:3941Google Scholar
16Mallett, V, Bhatia, R, Kissner, D, Sokol, R. Use of an HeO2 mixture in the management of upper airway obstruction during labor and delivery. A case report. J Reprod Med 1989;34:429–30Google Scholar
17Salama, D, Body, S. Management of a term parturient with tracheal stenosis. Br J Anaesth 1994;72:354–7Google Scholar
18Pauzner, R, Mayan, H, Hershko, E, Alcalay, M, Farfel, Z. Exacerbation of Wegener's granulomatosis during pregnancy: report of a case with tracheal stenosis and literature review. J Rheumatol 1994;21:1153–6Google Scholar
19Ratner, EF, Cohen, SE, El Sayed, Y, Druzin, M. Mask induction with sevoflurane in a parturient with severe tracheal stenosis. Anesthesiology 2001;95:553–5Google Scholar
20Darjani, HRJ, Parsa, T, Pirzeh, A, Heydarnazhad, H. Idiopathic subglottic stenosis in a pregnant woman: successful treatment with dilatation and Nd: YAG laser ablation. Tanaffos 2007;6:5862Google Scholar
21Rumbak, M, Dryer, J, Padhya, T, Camporesi, E, Karlnoski, R, Mangar, D. Successful management of subglottic stenosis during the third trimester of pregnancy. J Bronchology Interv Pulmonol 2010;17:342–4Google Scholar
22Engel, NM, Gramke, HF, Peeters, L, Marcus, MA. Combined spinal-epidural anaesthesia for a woman with Wegener's granulomatosis with subglottic stenosis. Int J Obstet Anesth 2011;20:94–5Google Scholar
23Nanjegowda, N, Srinivasan, N. Undiagnosed tracheal stenosis complicating airway management in pregnancy. Sri Lankan J Anaesthesiol 2011;19:86–8Google Scholar
24Karippacheril, JG, Goneppanavar, U, Prabhu, M, Revappa, KB. Idiopathic subglottic stenosis in pregnancy: a deceptive laryngoscopic view. Indian J Anaesth 2011;55:521–3Google Scholar
25Nash, Z, Krishna, A, Darwish, M, Mascarenhas, L. Conservative management of subglottic stenosis in pregnancy resulting in vaginal birth. BMJ Case Rep 2014;2014:bcr2013202137Google Scholar
26Carness, JM, Berman, JL. Awake microlaryngoscopy and serial balloon dilation in a third trimester multigravida with subglottic tracheal stenosis: anesthetic implications. A A Case Rep 2014;3:166–8Google Scholar
27Cunningham, FG. Williams Obstetrics. New York: McGraw-Hill, 2010Google Scholar
28Modgil, G, Havas, T, Mellis, C. Idiopathic subglottic stenosis and the relationship to menses in a 12-year-old girl. J Paediatr Child Health 2005;41:374–6Google Scholar
29Ananth, CV, Vintzileos, AM. Medically indicated preterm birth: recognizing the importance of the problem. Clin Perinatol 2008;35:5367Google Scholar
30Daumerie, G, Su, S, Ochroch, EA. Anesthesia for the patient with tracheal stenosis. Anesth Clin 2010;28:157–74Google Scholar
31ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 474: nonobstetric surgery during pregnancy. Obstet Gynecol 2011;117(2 Pt 1):420–1Google Scholar
32Kuczkowski, K, Benumof, J. Subglottic tracheal stenosis in pregnancy: anaesthetic implications. Anaesth Intensive Care 2003;31:576–7Google Scholar
33Tam, K, Jeffery, C, Sung, CK. Surgical management of supraglottic stenosis using intubationless Optiflow. Ann Otol Rhinol Laryngol 2017;126:669–72Google Scholar