[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-444459-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-444459-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","when-neonates-require-anesthesia-for-the-management-of-airway-related-problems","When Neonates Require Anesthesia for the Management of Airway-Related Problems","","Suspension laryngoscopy supports the diagnosis and treatment of neonatal airway pathologies such as subglottic stenosis, yet dosing of commonly used sedation raises concern about dose-dependent respiratory depression and safety. This open-access case discussion describes a premature neonate with respiratory failure and stridor scheduled for suspension laryngoscopy. Anesthetic planning used sevoflurane, ketamine, and dexmedetomidine with topical airway anesthesia to preserve airway tone, minimize respiratory depression and desaturation risk, and provide effective analgesia.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/when-neonates-require-anesthesia-for-the-management-of-airway-related-problems/444459/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/when-neonates-require-anesthesia-for-the-management-of-airway-related-problems/444459.png","ImageObject",300,407,{"name":42,"@type":43},"McGucket","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is suspension laryngoscopy important for neonates with airway problems?","Question",{"text":63,"@type":64},"It is a valuable tool for diagnosing and treating airway pathologies such as subglottic stenosis in neonates.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What concerns influence anesthetic drug selection in this neonatal case?",{"text":68,"@type":64},"Dose-dependent respiratory depression and the safety profile of sedation drugs, especially in premature infants with immature respiratory control, drive the selection.",{"name":70,"@type":61,"acceptedAnswer":71},"What anesthetic plan was chosen for the procedure?",{"text":72,"@type":64},"The plan combined sevoflurane, ketamine, and dexmedetomidine, supported by topical airway anesthesia with atomized lidocaine, and monitored with pulse oximetry and end-tidal CO2.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},444459,1790990144,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":124,"preview_page_count":4},1236954412713,"https://us-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review began 11/24/2025  \nReview ended 12/03/2025  \nPublished 12/07/2025  \n© Copyright 2025  \nMaio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98631  \nOpen Access Case Report  \nWhen Neonates Require Anesthesia for the Management of Airway-Related Problems  \nBeatriz Maio 1 , Marisa Silva 2  \n1. Anesthesiology, Hospital da Luz Lisboa, Lisbon, PRT 2. Anesthesiology, Unidade Local de Saúde de São José, Hospital Dona Estefânia, Lisbon, PRT  \nCorresponding author: Beatriz Maio, [mbhmaio@gmail.com](mbhmaio@gmail.com)  \nAbstract  \nSuspension laryngoscopy is a valuable tool for the diagnosis and treatment of airway pathologies such as subglottic stenosis in neonates. Propofol and remifentanil sedation are commonly used drugs for this purpose, but there is still concern about their dose-dependent respiratory depression and safety profile in neonates. This clinical case-based discussion presents a premature neonate with respiratory failure and stridor, scheduled for a suspension laryngoscopy. An anesthetic plan using sevoflurane, ketamine, and dexmedetomidine was chosen. This combination preserves airway tone and minimizes the risk of respiratory depression and desaturation, making it an ideal choice for neonates with airway abnormalities.  \nCategories: Pediatrics, Anesthesiology  \nKeywords: airway management, airway topical anesthesia, anesthetic plan, dexmedetomidine, ketamine, neonatal anesthesia  \nIntroduction  \nSubglottic stenosis in neonates is a serious condition that can lead to significant airway compromise and respiratory distress. While it can be congenital, acquired forms of subglottic stenosis are more common, typically due to prolonged intubation or trauma to the airway [1] . This article discusses a clinical scenario involving a two-month-old (22-day-old corrected gestational age) premature neonatal patient with congenital subglottic membrane and acquired subglottic stenosis secondary to mechanical ventilation. The patient was scheduled for a suspension laryngoscopy to assess and potentially treat the underlying stenosis. The primary concern was the unfavorable respiratory physiology typical of premature infants, including structurally immature lungs and immature control of breathing. In addition, the risk that endotrachealintubation might fail to pass beyond the obstruction was an important consideration. Therefore, an anesthetic plan combining sevoflurane, ketamine, and dexmedetomidine was selected to minimize the risk of compromising spontaneous ventilation. This drug combination, together with topical airway anesthesia, helps preserve airway tone and reduces the risk of respiratory depression. It also provides effective analgesia, with each medication offsetting the other’s side effects, making it a safer alternative to many commonly used agents in neonatal airway management.  \nCase Presentation  \nThis article presents a clinical case involving a preterm neonate born at 33 weeks’ gestation from amonochorionic, monoamniotic twin pregnancy, with a low birth weight of 1740 g. Due to neonatal sepsis, he was intubated and remained on invasive ventilation for 15 days. He was discharged home on day 55 afterbirth with 2465 g. Eight days after discharge, he presented in the emergency department with respiratory failure and biphasic stridor, suggesting airway obstruction. Emergent suspension laryngoscopy was proposed to diagnose and potentially treat the underlying etiology.  \nGiven the anticipated difficult airway, specifically the risk of not being able to advance an endotracheal tube past the obstruction and the potential for rapid desaturation in a premature neonate with immature ventilatory control, and the requirement to assess the biphasic stridor under spontaneous breathing, the chosen ane","cbCairWbUZ6VAnnt","https://ap.wps.com/l/cbCairWbUZ6VAnnt","pdf",1234848,"English","# Abstract\n# Introduction\n# Case Presentation\n## Preterm history and presentation\n## Anesthetic approach and monitoring\n## Procedure and airway topical anesthesia","[{\"question\":\"Why is suspension laryngoscopy important for neonates with airway problems?\",\"answer\":\"It is a valuable tool for diagnosing and treating airway pathologies such as subglottic stenosis in neonates.\"},{\"question\":\"What concerns influence anesthetic drug selection in this neonatal case?\",\"answer\":\"Dose-dependent respiratory depression and the safety profile of sedation drugs, especially in premature infants with immature respiratory control, drive the selection.\"},{\"question\":\"What anesthetic plan was chosen for the procedure?\",\"answer\":\"The plan combined sevoflurane, ketamine, and dexmedetomidine, supported by topical airway anesthesia with atomized lidocaine, and monitored with pulse oximetry and end-tidal CO2.\"}]","When Neonates Require Anesthesia for the Management of Airway-Related Problems | PDF",1790708098]