Rigid Bronchoscopy and Surgical Airway Procedures, Foreign Body Aspiration, and Gastric Content Aspiration Management

2021 ◽  
pp. 75-94
Author(s):  
Audra Webber ◽  
John Faria
Keyword(s):  
Foreign Body ◽  
Difficult Airway ◽  
Premature Infants ◽  
Gastric Content ◽  
Rigid Bronchoscopy ◽  
Pediatric Airway ◽  
Prolonged Intubation ◽  
Surgical Airway ◽  
Perioperative Course ◽  
Invasive Techniques

The difficult airway in pediatric patients is most frequently anticipated because of anatomic anomalies from craniofacial pathology. With the increasing population of surviving premature infants who require prolonged intubation perinatally, chronic issues such as subglottic stenosis are also becoming more common. When dealing with the difficult pediatric airway, preparation and communication are key. It is essential to have a continuous dialogue between the otolaryngologist and the anesthesiologist throughout the perioperative course. When involved with a patient who is likely to have a difficult airway, it is best to involve or consult the pediatric otolaryngologist as early in the process as possible. This chapter outlines the most common invasive techniques for management of the pediatric non-normal difficult airway: rigid bronchoscopy and tracheostomy. This chapter will also review the management of an airway foreign body and aspirated gastric contents.

scholarly journals Removal of an inhaled stoma button distal to a reactionary tracheal stenosis: a difficult airway case

2019 ◽  
Vol 12 (8) ◽  
pp. e230392
Author(s):  
Gillian Gray ◽  
Mark Adams ◽  
Myles Black ◽  
Pushpinder Sidhu
Keyword(s):  
Foreign Body ◽  
Difficult Airway ◽  
Tracheal Stenosis ◽  
Surgical Approach ◽  
Balloon Dilatation ◽  
Rare Case ◽  
Rigid Bronchoscopy ◽  
Shortness Of Breath

We present the complex and rare case of an inhaled stoma button causing proximal tracheal stenosis in a laryngectomy patient. The patient was unaware he had inhaled his button and presented with increasing shortness of breath and noisy breathing. In this case we discuss the challenging management of the stenotic tracheal segment above the impacted stoma button and the surgical approach to this difficult airway. The distal foreign body was safely removed using rigid bronchoscopy and balloon dilatation. This difficult airway required multidisciplinary input from the ENT, cardiothoracic and anaesthetic teams.

scholarly journals Expecting the unexpected, foreign body bronchus masquerading as subglottic stenosis: A Case Report

2021 ◽  
Author(s):  
Deepak Paudel ◽  
Raunak Dahal ◽  
Bajarang Sah ◽  
Shyam Chettri ◽  
Pravid Gajurel
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Rare Event ◽  
Rigid Bronchoscopy ◽  
Subglottic Stenosis ◽  
Suspected Case ◽  
Betel Nut ◽  
Prolonged Intubation ◽  
Foreign Body Bronchus ◽  
Partial Hanging

It is a rare event that a patient suspected to have a subglottic stenosis actually has a foreign body bronchus. We report a suspected case of subglottic stenosis secondary to partial hanging and prolonged intubation. However, surprisingly the rigid bronchoscopy revealed a betel nut at the level of carina.

The Utility of Endoscope-Assisted Rigid Bronchoscopy in Pediatric Airway Foreign Body Removals

2020 ◽  
Vol 31 (2) ◽  
pp. e217-e219 ◽  
Author(s):  
Suleyman Ozdemir ◽  
Ozgur Surmelioglu ◽  
Ozgur Tarkan ◽  
Ulku Tuncer ◽  
Mete Kiroglu ◽  
...  
Keyword(s):  
Foreign Body ◽  
Rigid Bronchoscopy ◽  
Pediatric Airway ◽  
Airway Foreign Body

scholarly journals Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weigang Gan ◽  
Ning Xiao ◽  
Yiyuan Feng ◽  
Danmei Zhou ◽  
Juanjuan Hu ◽  
...  
Keyword(s):  
Foreign Body ◽  
Pediatric Patients ◽  
Treatment Delay ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
External Factors ◽  
Factors Affecting ◽  
Intrinsic Factors ◽  
Common Location ◽  
Tracheobronchial Foreign Body

Abstract Background Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. Methods We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. Results The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. Conclusion Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

scholarly journals Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience

2021 ◽  
Author(s):  
Darwin Kaushal ◽  
Amit Goyal ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
Nithin Prakasan Nair ◽  
...  
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Preoperative Planning ◽  
Rigid Bronchoscopy ◽  
Delayed Presentation ◽  
Betel Nut ◽  
Key Factors ◽  
Tracheobronchial Foreign Body ◽  
Institutional Experience ◽  
Definitive Management

Abstract Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

Catheter‐Guided Basket Removal of a Difficult‐to‐Reach Pediatric Airway Foreign Body

2021 ◽  
Author(s):  
Alexander Gabinet‐Equihua ◽  
Sharon L. Cushing ◽  
Evan J. Propst ◽  
Nan Gai ◽  
Nikolaus E. Wolter
Keyword(s):  
Foreign Body ◽  
Pediatric Airway ◽  
Airway Foreign Body

Emergency Surgical Airway Algorithm for Difficult Airway Management During the COVID-19 Pandemic

2021 ◽  
pp. 019459982098656
Author(s):  
Soham Roy ◽  
John D. Cramer ◽  
Carol Bier-Laning ◽  
Patrick A. Palmieri ◽  
Christopher H. Rassekh ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management ◽  
Surgical Airway

scholarly journals Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

2019 ◽  
Vol 5 (4) ◽  
pp. 1129
Author(s):  
Sagar Jawale ◽  
Parthapratim Gupta ◽  
Bharti Kulkarni
Keyword(s):  
Foreign Body ◽  
Gold Standard ◽  
Medical Literature ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Indian Children ◽  
Foreign Body Removal ◽  
Rigid Tube ◽  
Pass Through ◽  
First Time

<p>Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.</p><p> </p>

scholarly journals Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

2020 ◽  
Author(s):  
Bo Liu ◽  
Fengxia Ding ◽  
Yong An ◽  
Yonggang Li ◽  
Zhengxia Pan ◽  
...  
Keyword(s):  
Foreign Body ◽  
Medical Records ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Previous History ◽  
Rigid Bronchoscopy ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Male Patients ◽  
Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

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