post operative croup (POST-INTUBATION STRIDOR)

POST-INTUBATION STRIDOR

Post-extubation stridor is usually seen after use of a tight-fitting endotracheal tube (either a cuffed one or a large size uncuffed one), repeated intubation and trauma, coughing and straining on the tube. Because subglottic region is the narrowest part of the paediatric airway, even a tube which passes the vocal cords smoothly might cause mucosal trauma and oedema and significant airway obstruction. Humidified cold mist after extubation, mild sedation might be helpful in mild croup. Racemic adrenaline administered by nebuliser for 5 to 10 minutes helps in producing vasoconstriction and minimising tissue oedema. Dexamethasone is not effective in immediate post-operative period but a dose of 0.5 mg/kg has been used 6 hourly for 4 to 6 doses by some anaesthetists. Rarely, a child might require reintubation with a smaller size tube.

Common post-operative complications in children, Indian J Anaesth. 2012 Sep-Oct; 56(5): 496–501.

 

Postintubation croup caused by glottic, laryngeal, or tracheal edema is
particularly serious in children. The efficacy of corticosteroids (eg,
dexamethasone—0.2 mg/kg, up to a maximum of 12 mg) in preventing
postextubation airway edema remains controversial, but this approach is often
used.

Clinical Anesthesiology by Morgan and Mikhail 6th edition. 2018 : 578.