General Anesthetic Exposure in the Management of Pediatric Subglottic Stenosis

ABSTRACT Objectives This study describes time spent under general anesthesia (GA) and number of procedures in children with subglottic stenosis (SGS) treated with endoscopic balloon dilation (EBD), laryngotracheal reconstruction (LTR), or both. Methods Children treated for SGS surgically between November 2014 through August 2020 were included. Patients with completed treatment course, defined as not having an airway intervention for a 12‐month period, were included. All procedures important to the overall management of SGS were included. Results Thirty‐one children met inclusion criteria. Median age at first procedure was < 1 year of age, with 80.6% of patients undergoing GA before age 3. Children who had an LTR ( n = 13) received 17.1 ± 7.9 h of anesthesia and 11.1 ± 4.9 procedures associated with their treatment course. Children treated with EBD alone ( n = 18) had 6.2 ± 3.0 h of anesthesia and 5.9 ± 3.5 procedures during their treatment course. The average duration of GA exposure and number of procedures increased with increasing SGS grade. Each EBD was associated with an additional 0.96 h of anesthesia while each LTR procedure was associated with 7.0 h of additional anesthesia. Conclusions GA exposure and number of procedures increased with increasing degree of stenosis. Undergoing LTR predicted a significant increase in GA exposure and number of procedures compared to patients managed with EBDs alone. While anesthesia exposure may not be a decisive factor in selecting a treatment course, it remains an important topic to discuss with parents, especially given increasing awareness of its potential risks to neurocognitive development.