Postoperative Medical Management in Single-Stage Laryngotracheoplasty

OBJECTIVE: To determine whether it is safe and effective to avoid the use of neuromuscular relaxants in patients who have indwelling nasotracheal tubes after undergoing single-stage laryngotracheoplasty. DESIGN: Retrospective case series. SETTING: University-based referral center specializing in the surgical management of laryngotracheal stenosis and other pathologic conditions of the airway. PATIENTS: Referred sample of 104 consecutive patients (67 males, 37 females) undergoing single-stage laryngotracheoplasty for subglottic stenosis. INTERVENTION: Single-stage laryngotracheoplasty. MAIN OUTCOME MEASURES: Incidence of accidental extubation, use of neuromuscular relaxants, incidence of reintubation after planned extubation, duration of intubation, overall rate of successful airway expansion. RESULTS: One patient self-extubated without sequelae. One patient required a brief course of neuromuscular relaxants. The success rate (without further laryngotracheoplasty) for all patients was 86% (89/104). For the 25 patients operated on in 1992, with at least 1 year of follow-up, the success rate was 92% (23/25). CONCLUSION: Single-stage laryngotracheoplasty can be done safely and effectively without using paralyzing agents in the postoperative period. This approach has certain advantages, which are discussed.