Abstract
There is at present, very little information on congenital laryngomalacia in the anaesthetic literature. The purpose of this article is to review this topic, which in 90% of patients represents a benign self-limiting condition, disappearing by the age of two to five years. However, if untreated, the remaining 10% of cases can prove fatal. This severe form presents as persistent sternal recession, feeding difficulties, and failure to thrive, progressing to apnoeic attacks, cor pulmonale and eventually death. The developmental and functional anatomy of the larynx will be included, with a discussion of the pathophysiology and history of the disorder. Its diagnosis and a résumé of the various treatment strategies, will be presented. The anaesthetic management is controversial as is the surgical technology. Our technique, for diagnosis or definitive repair, is based upon suspension laryngoscopy using topical local analgesia and spontaneous ventilation. Halothane is then administered by insufflation into the pharynx, using a #8 nasopharyngeal catheter, and suction is applied to the mouth. During the surgical repair, an endotracheal tube (ETT), may be inserted, at the discretion of the anaesthetist and surgeon. Finally, the role of the carbon dioxide CO2 laser and its hazards will be introduced.
Résumé
Jusqu’à présent, la littérature anesthésique donne très peu d’information sur la laryngomalacie congénitale. Le propos de cet article est de revoir ce sujet, qui dans 90% des cas est bénin et disparaît vers l’âge de 2 à 5 ans. Cependant, les 10% des cas restant peuvent devenir léthaux s’tis ne sont pas traités. Cette forme grave se manifeste par un enfoncement sternal persistant, des difficultés d’alimentation et un retard de croissance. Elle s’aggrave de crises apnéiques, de coeur pulmonaire et éventuellement il y a décès. L’anatomie fonctionnelle ainsi que le développement du larynx sont décrits avec une discussion de la physiopathologie et de l’histoire du désordre. On présente également le diagnostic et un résumé des différents traitements. Autant la démarche anesthésique que la technique chirurgicale sont controversées. Notre technique de diagnostic et de réparation définitive est basée sur une laryngoscopie en suspension réalisée sous analgésie locale et ventilation spontanée. L’halothane est ensuite administré par insufflation pharyngée à l’aide d’un cathéter nasopharyngé n° 8 et une succion est appliquée à la bouche. Au cours de la réparation chirurgicale, un tube endotrachéal peut être inséré à la discrétion de l’anesthésiste et du chirurgien. Finalement, le rôle du laser au CO2 et ses risques sont évoqués.
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Baxter, M.R.N. Congenital laryngomalacia. Can J Anaesth 41, 332–339 (1994). https://doi.org/10.1007/BF03009914
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DOI: https://doi.org/10.1007/BF03009914