Etiologies and Clinical Courses of Stridor with Respiratory Distress of Non-infectious Origin in Infants and Children / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to investigate the causes of stridor with respiratory distress and their clinical courses in children. METHODS: Children who were hospitalized in Samsung Medical Center due to stridor with respiratory distress without infectious causes were studied retrospectively. The causes of stridor, sex, age at onset, symptoms, combined diseases, treatment, and clinical courses were investigated. Fisher's exact test was used to assessing the association of risk factors with the severity of post-intubation subglottic stenosis. RESULTS: Of 75 cases, 15 (20 percent) were congenital and 60 (80 percent) were acquired. The prevalence in males was higher than in females. Common causes of congenital stridor were laryngomalacia, tracheomalacia, pulmonary artery sling and complete tracheal ring. Acquired stridor is usually due to subglottic stenosis secondary to endotracheal intubation. Risk factors such as frequency and duration of intubation, age at first intubation, birth weight and gestational age were not associated with the developement of post-intubation subglottic stenosis. (P> 0.05) More complicated surgical treatment was required according to the severity of subglottic stenosis. CONCLUSION: Congenital malformation of the airway requiring urgent surgical correction should be differentiated in children with stridor and respiratory distress. Post-intubation subglottic stenosis accounts for most cases of acquired stridor. Evaluation of it's severity, and careful airway care, is required in children with subglottic stenosis.

Comparison of Postoperative Apneic Episodes after General and Spinal Anesthesia for Inguinal Herniorrhaphy among very Low Birth Weight Infants

PURPOSE: The objective of this study was to compare the incidences of postoperative apnea in between either spinal or general anesthesia for inguinal herniorrhaphy among very low birth weight (VLBW) infants. METHODS: Retrospective chart review for 28 infants less than 1, 500gram birth weight who underwent inguinal hernia repair at Samsung Medical Center from January 1994 to May 2002 was done. These infants had been already weaned from ventilator before inguinal herniorrhaphy. The subjects were divided into two groups according to the type of anesthesia they received for the hernia repair. RESULTS: There were no statistically significant differences in gestational age, birth weight, corrected gestational age, body weight at the time of operation, duration of mechanical ventilator and duration of oxygen requirements in between groups with general anesthesia (13 cases) and spinal anesthesia (15 cases). The incidences of apnea and requirement of oxygen for 24 hours preoperatively did not show significant differences in between two groups, however, the postoperative incidences of apnea, requirement of oxygen and ventilator care were less in spinal anesthesia group. One infant of general anesthesia group who required postoperative mechanical ventilator eventually ended up with tracheostomy due to ventilator weaning failure. CONCLUSION: This study suggests that the spinal anesthesia for VLBW infants who underwent inguinal herniorrhaphy significantly decreased the incidences of postoperative apnea compared to those infants with general anesthesia.