Pediatric acquired subglottic stenosis is a high-risk airway condition that requires close coordination between anesthesiology and otorhinolaryngology teams, particularly during endoscopic interventions performed under shared-airway conditions. This report describes the interdisciplinary management and anesthetic–surgical coordination in a child with severe acquired subglottic stenosis undergoing endoscopic balloon dilation, highlighting key decision points and airway management strategies. A 2-year-old boy with a history of prolonged and repeated endotracheal intubations presented with persistent dyspnea and noisy breathing, consistent with fixed extrathoracic airway obstruction. The case was reviewed in a multidisciplinary pediatric difficult-airway meeting, and operative management consisted of endoscopic airway evaluation and balloon dilation performed under preserved spontaneous ventilation. Intraoperative endoscopy demonstrated approximately 80% subglottic luminal narrowing consistent with Cotton–Myer Grade III stenosis, and initial intubation across the stenotic segment was not possible. Radial scar release followed by sequential balloon dilations was successfully performed under shared-airway conditions. Transient oxygen desaturation occurred during balloon inflation but resolved with coordinated airway management and interval reoxygenation. Post-dilation airway calibration demonstrated improved patency. The patient was monitored postoperatively in the intensive care unit, extubated after 24 hours, and experienced no immediate complications. Short-term follow-up revealed stable respiratory status without recurrent symptoms, with planned staged surveillance and repeat dilation. This case demonstrates that severe pediatric subglottic stenosis can be managed safely with endoscopic balloon dilation when supported by meticulous interdisciplinary planning, preservation of spontaneous ventilation, and real-time communication between anesthesiology and surgical teams, potentially avoiding tracheostomy in selected high-risk pediatric patients.
Gunawan et al. (Wed,) studied this question.