Sedation after airway reconstruction in children: A protocol to reduce withdrawal and length of stay.

INTRODUCTION The optimal pharmacologic and critical care–specific management during the necessary phase of postoperative intubation following complex airway surgery remains challenging. Authors have described the use of various sedation agents following a number of reconstructive surgeries including laryngotracheal reconstruction, laryngeal cleft repair, and supraglottoplasty. In reference to laryngotracheal reconstruction in particular, several studies have advocated for minimal sedation and avoidance of paralytics in older children. However, it is understood that postoperative sedation is required in infants, toddlers, and children who are incapable of understanding instructions to limit movement and avoid manipulation of the nasotracheal tube. Often, there exists significant variation in practice among critical care physicians and surgeons, even within the same hospital, in terms of sedation agents used, duration of intubation, and use of paralytics following airway surgeries that require a period of postoperative sedation. In an effort to address such variations, we codesigned a clinical pathway directing all aspects of postoperative management following all complex airway procedures at our institution. In this report we describe our protocol for postoperative sedation and critical care management following major airway reconstruction in children <5 years old. With adherence to this management strategy, we have standardized our approach to the sedation and daily management of young children undergoing complex airway procedures, greatly reducing medication tapers and minimizing postoperative length of stay (LOS).