Postoperative Stridor and Respiratory Failure Following Hypospadias Repair in a Toddler with Prior Croup: A Case Report

Abstract

Postoperative stridor is an uncommon but potentially life‑threatening complication in pediatric anesthesia. We report a 22‑month‑old boy undergoing elective hypospadias repair who developed severe postoperative stridor and respiratory failure despite an uneventful anesthetic course. Initial therapy with systemic corticosteroids and nebulized epinephrine provided temporary improvement, but progressive airway obstruction necessitated high‑flow nasal cannula, followed by endotracheal intubation and mechanical ventilation. Subglottic edema and pulmonary opacities consistent with atelectasis or aspiration contributed to respiratory distress. The patient recovered after 72 hours of ventilatory support. This case highlights the importance of meticulous preoperative airway evaluation, early recognition of postoperative airway compromise, and a low threshold for escalation in children with prior upper airway disease.

Keywords: Postoperative stridor, Pediatric anesthesia, Subglottic edema, Upper airway obstruction, Hypospadias repair, Respiratory failure.