Nursing Management of Acute Airway Hyperresponsiveness and Stenosis in a Pediatric Patient Undergoing Adjustable Spinal Device Surgery: A Case Report.

Pediatric adjustable spinal device surgery, while generally low-risk, can pose severe perioperative airway challenges. This case report details the first documented instance of a 6-year-old girl developing acute airway hyperresponsiveness and severe extrinsic tracheal stenosis following sequential spinal rod adjustments. Adhering to CARE guidelines, we describe a multidisciplinary nursing management strategy that successfully addressed this life-threatening dual pathology. Key interventions included protocol-driven management of bronchospasm with deep sedation and bronchodilators, early recognition and imaging of stenosis, a rigorous ventilator-associated pneumonia prevention bundle, meticulous planning for safe transfers, and comprehensive supportive care for nutrition, neurological symptoms, and skin integrity. These measures collectively stabilized the airway, reduced peak inspiratory pressure, and maintained oxygen saturation above 95%. Ventilator-associated pneumonia was prevented, a stage-2 pressure injury healed, and postoperative delirium and seizures resolved, leading to discharge on day 9. This case underscores the critical need for proactive airway surveillance, especially with three-dimensional imaging in high-risk pediatric spinal cases, and the value of integrated, evidence-based nursing protocols within a multidisciplinary framework to manage complex perioperative complications.