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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(01): 063-065
DOI: 10.1055/s-0042-1758748
Case Report

Not All Postoperative Stridor in Infants Is Due to Endotracheal Tube-Induced Subglottic Edema

Ramamani Mariappan
1   Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Rebecca A. Ninan 
2   Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Krishnaprabhu Raju
3   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

A 6-month-old infant presented with clinicoradiological features of a shunt dysfunction. Magnetic resonance imaging brain showed multiple leptomeningeal cysts in the posterior fossa, with the largest in the right cerebellopontine (CP) angle cistern causing compression on the brain stem and fourth ventricle. There was gross hydrocephalus with the malpositioned shunt tube. He underwent shunt revision followed by right retromastoid craniectomy and decompression of the right CP angle cyst. Following extubation, he developed stridor that was diagnosed initially as subglottic edema and treated with humidified oxygen, systemic corticosteroids, and nebulized adrenaline. Failure to resolve the symptoms warranted a video laryngoscopy that revealed right vocal cord palsy (VCP), and he was reintubated. He was started on steroids and got extubated on a nasal continuous positive airway pressure and was gradually weaned off. Intraoperative handling of the vagus nerve while decompressing the cyst led to a right VCP, which was communicated later to the anesthesiologist. Neurological cause and association need to be considered as one of the differentials while managing postoperative stridor after posterior fossa surgery in an infant. Timely communication between the surgeon and anesthesiologist is paramount for reducing morbidity.

Keywords

infant - postoperative stridor - posterior fossa surgery - vocal cord palsy - ventriculoperitoneal shunt


Publikationsverlauf

Artikel online veröffentlicht:
06. Februar 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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