Anesthesia Management of a Child with Laryngeal Malacia

Laryngeal malacia is the most common disease causing laryngeal wheezing in infants and young children, and its pathogenesis is not clear at present. We report the case of a child with congenital laryngomalacia who underwent general anesthesia and successfully completed laryngeal reconstruction and plastic surgery. Physical examination of the patient revealed depression of the suprasternal notch during inspiration. Preoperative imaging studies and laryngoscopy indicated laryngomalacia and airway stenosis. Preoperative anesthesia assessment suggested potential difficulty with mask ventilation and intubation. Due to the patient being a young infant unable to follow commands in a conscious state for tracheal intubation, the final decision was made to use general anesthesia that maintains spontaneous breathing under sedation for anesthesia induction. Given the young age of the pediatric patient, high airway reactivity, and tendency for edema, a method was employed that involved administering steroids, anticholinergic drugs, and local anesthetics via nebulization before general anesthesia. This approach significantly reduced airway reactivity and decreased airway secretions. And we chose a smaller tracheal tube to establish an artificial airway. Anesthesia is induced by full local airway anesthesia, full sedation, and maintenance of spontaneous respiration, maintained during anesthesia with inhalation and intravenous anesthesia drugs. The entire anesthesia induction process did not show signs of hypoxia in the child. The operation was successfully completed and the extubation was successful 11 days after surgery.