JRRP and Anesthesia
JRRP requires numerous diagnostic and therapeutic interventions. This can require up to 10 or more general anesthetics per year. Some children with JRRP may undergo general anesthesia over 100 times in their lifetime.
The risks for general anesthesia are quite low overall, as most children with JRRP are otherwise healthy. Major complications are associated with the obstructions associated with the papillomata, which can cause complete obstruction of the breathing system. Your team of surgeons and anesthesiologists must work closely together and prepare a safe plan for each trip to the operating room. This should include a discussion with the family about the planned anesthetic, risks, and possible outcomes after surgery including admission to a pediatric intensive care unit or the need for a breathing tube to protect your child’s airway.
At Mass. Eye and Ear, we often do not need to start an IV before surgery. If children are breathing, it is safe for them to go to sleep with a mask. If there is too much obstruction, sometimes we will need an IV first. There are three methods for providing a safe anesthetic: paralysis and a breathing tube/ intermittent apnea; paralysis and a high pressure “jet” ventilation system or spontaneous ventilation without a breathing tube. We typically use the tubeless technique without paralysis. This strategy reduces the risk of complications related to paralysis, minimizes trauma associated with passing a breathing tube into the area with papillomata, and allows your child to breathe naturally.
Anytime surgery is performed on a child’s airway, we must be careful to ensure there is no swelling or any unforeseen complications. Thankfully, most children with JRRP breathe much more easily after surgery and within a few hours, we can safely discharge them home. If there is noisy breathing, low oxygen saturations, or other concerns, we may need to monitor your child overnight and administer medications to relieve these symptoms.
Anesthetics are safe and effective, but every day we learn more about how to improve our use of the many drugs available to us. Emerging evidence suggests that some anesthesia medications can injure the brain cells of very young mammals, including humans. With so many general anesthetics needed to treat JRRP, we are following these studies closely to change our practice should compelling evidence come forward. For now, we are careful about how much anesthetic we use, we try to keep the surgeries as short as possible, and we work to use the safest combination of drugs possible. Our tubeless technique, for example, uses an intravenous combination of two medications that are specifically not associated with this pattern of brain cell injury.
In conclusion, pediatric anesthesia is a complex art that attempts to provide care to many children with serious conditions. We appreciate open communication with children and their families to help us make critical decisions together. JRRP is a difficult disease that requires expert care and a team that works well together to get the safest and most successful outcome for your child.