Reducing the need for general anesthesia in the repair of choanal atresia with steroid-eluting stents: A case series

Abstract

Introduction: Choanal atresia (CA) is a rare pediatric congenital disorder resulting in upper airway obstruction and respiratory distress in the setting of obligate nasal breathing in infants. In 2016, a novel technique was reported in the literature utilizing drug-eluting stents to correct CA. However, 2 out of 3 patients in the study required a second operation under general anesthesia. The repeated visits to the operating room for evaluations and debridement under general anesthesia continues to be a concern for increased morbidity and mortality in infants undergoing repair of CA.

Methods: A case series of three (3) patients who underwent repair of CA. Outcomes were measured by post-operative, in-office flexible nasoendoscopy.

Results: Each patient was implanted with mometasone furoate drug-eluting stents at the conclusion of the operation. Post-operatively, patients were instructed to perform nasal saline rinses 3-4 times daily. Outpatient follow-up between 6 and 17 months showed patent nasal passages on nasal endoscopy. There were no post-operative complications. Moreover, patients only underwent a single episode of general anesthesia at time of initial repair.

Conclusions: In our study, we report successful outcomes using drugeluting stents for one-stage surgical correction of CA, therefore negating the need for children to undergo multiple subjections to general anesthetics.

Keywords: Choanal atresia; Congenital anomalies; Drug-eluting stent; Pediatric anesthesia.