Objective:To summarize the clinical features and experience in diagnosis and treatment of subglottic cysts in children.Methods:The clinical data of 5 children with subglottic cysts admitted in Qilu Children′s Hospital of Shandong University from April 2018 to June 2019 were retrospectively analyzed.Results:Among the 5 patients, 2 cases were premature infants and 3 cases were full term infants.All patients had an endotracheal intubation history.One patient was asymptomatic.Four patients had laryngeal stridor, 2 cases of whom were accompanied by hoarseness and dyspnea.These 2 patients were used to be misdiagnosed with laryngomalacia, laryngitis, etc.Bronchoscopy revealed subglottic gray-white cyst-like lesions, and enhanced CT showed low density without enhancement.All patients were treated with laser and forceps, and bronchoscope was applied in the follow up period for 5-12 weeks.There was no recurrence or subglottic stenosis.Conclusions:Laryngeal stridor in children with a history of endotracheal intubation must be examined by bronchoscopy in time to find out whether there is subglottic cysts.Laser therapy is an effective treatment for subglottic cysts.

The clinical data of 4 children with congenital absence of tracheal cartilage ring in Qilu Children′s Hospital of Shandong University from November 2017 to August 2019 were retrospectively analyzed.The age of the 4 cases was from 2 months to 1 year.One case had no obvious symptoms after birth, and then had repeated wheezing attacks for 3 times.Another 3 cases had symptoms after birth, such as throat ringing, repeated cough and asthma.Bronchoscopy in 4 cases indicated that the local lumen of trachea was round and centripetal stenosis, but the body of bronchoscope could pass smoothly, and no cartilage structure was found in the wall of trachea.Among them, 3 cases of chest enhanced CT examination displayed local and hourglass-like tracheal stenosis, without vascular ring malformation.All the 4 cases were treated by operation, of which 3 cases recovered well and 1 case died of severe infection after operation.

Objective:To evaluate the pharmacodynamics of remimazolam tosilate inducing loss of consciousness (LOC) when combined with sufentanil in children.Methods:American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ pediatric patients of either sex, aged 3-6 yr, undergoing electronic bronchoscopy, were included in this study. ECG monitoring was carried out in all children after admission, sufentanil 0.1 μg/kg was intravenously injected slowly, and 3 min later remidazolam tosilate was intravenously injected. The dose of remimazolam tosilate was determined by the modified Dixon′s up-and-down sequential experiment, and the initial dose of remimazolam tosilate was 0.30 mg/kg. The dose of remimazolam tosilate in the next child was determined according to the the loss of consciousness, and the successive dose gradient was 0.05 mg/kg. Loss of eyelash reflex and Modified Observer′s Assessment of Alertness/Sedation Scale score reaching 0 and the occurrence of 8 crossover points where consciousness transitioned from non-disappearance to disappearance after 1 min of remimazolam tosilate injection were considered to be signs of LOC. The median effective dose (ED 50), 95% effective dose (ED 95), and their 95% confidence interval ( CI) of remimazolam tosilate inducing LOC were calculated using probit method. Results:When combined with sufentanil, the ED 50 and 95% CI of remimazolam tosilate inducing loss of consciousness were 0.461 (0.429-0.493) mg/kg, and the ED 95 and 95% CI were 0.515 (0.487-0.689) mg/kg. Conclusions:When combined with sufentanil, the ED 50 of remimazolam tosilate inducing LOC is 0.461 mg/kg and the ED 95 is 0.515 mg/kg in children.

Objective:To investigate the value of flexible bronchoscopy and neck ultrasound in percutaneous dilatational tracheotomy (PDT) in infants.Methods:The clinical data of 24 patients, who underwent flexible bronchoscopy and neck ultrasound assisted PDT in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University from December 2018 to May 2021, were retrospectively analyzed.Of the 24 cases, 12 were male and 12 female.The male to female ratio was 1∶1.The age range was 21 days to 2 years (median: 5 months). The median mass was 5.8 kg.During the PDT, neck ultrasound was used to assess the thyroid position and vascular shape of vessels.After determining the puncture approach and marking the tracheostomy site, the PDT was performed under the guidance of flexible bronchoscopy.Results:Before surgery, 19 children (79.2%) had received continuous endotracheal intubation mechanical ventilation support, 2 children (8.3%) were treated by intermittent endotracheal intubation mechanical ventilation support therapy, and 3 children (12.5%) were supported by the non-invasive ventilator.There were 9 cases (37.5%) of congenital upper respiratory tract malformation, 8 cases (33.3%) of bilateral vocal cord paralysis, 3 cases (12.5%) of upper respiratory tract neoplastic diseases, 2 cases (8.3%) of surgical evacuation difficulties, and 2 cases (8.3%) of neuromuscular disease.All 24 patients successfully completed the operation within 30 min, with bleeding volume less than 5 mL and no intraoperative complications.Conclusions:Flexible bronchoscopy and neck ultrasound can assist in the successful PDT in infants, significantly reduce the difficulty and improve the safety of PDT.

Objective:To summarize the clinical data of 18 children with primary tracheobronchial tumors, and to investigate the safety and effectiveness of bronchoscopy intervention therapy.Methods:The clinical features, signs, imaging and bronchoscope characteristics, pathology types, endoscopy intervention therapy methods, and outcomes of 18 patients with primary tracheobronchial tumors treated in Qilu Children′s Hospital of Shandong University from January 2013 to August 2019 were retrospectively analyzed.Results:The patients aged from 2 years old to 12 years old, and the ratio of male and female was 1.71∶1.There were 8 cases of mucoepidermoid carcinoma, 7 cases of inflammatory myofibroblastoma, 1 case of infant fibrosarcoma, 1 case of intermediate vascular tumor, and 1 case of acinar cell carcinoma.All 18 patients received the biopsy under general anesthesia to determine the pathological type of tumor and underwent the interventional therapy to relieve airway obstruction.No complications such as massive bleeding, pneumothorax, and mediastinal emphysema were observed during and after operation.The endoscope examination was applied to assess the curative effect 1 week after the surgery, complete response 17 case, inefficiency 1 case, and the overall effective rate was 94%.Conclusions:It is safe and reliable to treat primary tracheobronchial tumor by bronchoscopy intervention therapy, which can be used as a palliative treatment and create conditions for further radical operation.It may even become a radical cure for tracheobronchial tumors.

Objective:To explore the clinical typing, diagnostic method and treatment plan of congenital tracheal stenosis (CTS) combined with communicating bronchopulmonary foregut malformation (CBPFM) in children.Methods:The clinical data of 2 children with CTS and CBPFM who were treated in the Center for Respiratory Intervention of Children′s Hospital Affiliated to Shandong University in May 2021 and January 2022 were retrospectively analyzed.Studies were retrieved from domestic and foreign databases, so as to summarize the clinical characteristics of CTS complicated with CBPFM and investigate the typing method of CBPFM.Results:One patient was a 4-year-old girl, who sought the medical advice due to " recurrent cough and asthma for more than 4 years" . She was diagnosed with typeⅡ CBPFM at the right side and CTS.Surgical thoracoscopic right pneumonectomy plus oesophageal repair was performed.The other patient was a 7-month-and-2-day-old female, who visited the hospital for " difficult eating, dyspnea and purple lip cyanosis for 7 months" . This patient was diagnosed with typeⅡ CBPFM at the left side and CTS.Slide tracheoplasty and left pneumonectomy+ oesophageal repair were performed successively.Eight English and one Chinese studies were collected.Twenty-one children with CBPFM and 12 children with CTS and CBPFM were included.Eleven CTS cases with sufficient diagnostic evidence were complicated with typeⅠA and typeⅡCBPFM.Conclusions:CTS and CBPFM can lead to severe wheezing and dyspnea.Clinicians should enhance their awareness and be more cautious.There may be a potential link between CTS and typeⅠA and typeⅡCBPFM, and further investigation is required.

The data of a case of congenital subglottic stenosis (C-SGS) who underwent slide laryngotracheoplasty in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University in December 2021 was analyzed retrospectively.The patient was a girl aged 2 months and 15 days.She visited the hospital 23 days after tracheotomy due to dyspnea for more than 2 months.The bronchoscopy and annular cartilage B ultrasound results suggested subglottic stenosis and no scar hyperplasia.Based on the medical history, the child was diagnosed with C-SGS.Slide laryngotracheoplasty was performed 2 weeks after admission, and the tracheotomy tube was removed after surgery.The child was followed up 2 months after surgery, and she recovered well with no dyspnea.The study results suggest that early and safe slide laryngotracheoplasty after definite diagnosis can provide immediate and sufficient airway space for C-SGS patients, and protect their voice and swallowing function.

Objective To evaluate the efficacy and safety of midazolam combined with dexmedetomidine for sedation during magnetic resonance imaging(MRI)examination in children.Methods The medical records of children who underwent sedated MRI examinations at the Sedation Center of Children's Hospital Affiliated to Shandong University from August 2021 to July 2022 were collected.The patients were divided into three groups based on age:Infant group(age≤1 year old,922 cases),toddler group(1 year old