Sevoflurane based volatile induction/maintenance anesthesia for rigid bronchoscopy for tracheal or bronchial foreign body removal: A better choice than propofol-remifentanil intravenous anesthesia

2010 ◽  
Vol 27 ◽  
pp. 154
Author(s):  
R. Liao ◽  
G. Y. Liu
Author(s):  
Weiping wang ◽  
Shangyingying Li ◽  
Hui Liu ◽  
Qin Tian ◽  
Hang Chen ◽  
...  

Background: There is no consensus regarding the optimal anesthetic approach to rigid bronchoscopy in children suffering from tracheobronchial FBA. We performed this meta-analysis to assess the efficacy and safety of the different anesthesia agents and ventilation modes for tracheobronchial foreign body removal via rigid bronchoscopy in young children. Methods: A systematic search of three major databases for all relevant articles. A meta-analysis was performed to analyze the data. Results: Four trials for evaluating different anesthetics and six trials for evaluating two kinds of ventilation modes were found. Compared with the sevoflurane-based volatile anesthesia group , the rate of perioperative complications included hypoxemia (OR, 2.07; 95% CI, 1.38–3.11; P=0.0004; I2 = 0%), apnea (OR, 2.74; 95% CI, 1.11–6.78; P = 0.03; I2 = 60%), laryngospasm (OR, 2.89; 95% CI, 1.67–4.98; P=0.0001; I2 = 0%), cough/bucking (OR, 2.93; 95% CI, 1.86–4.63; P<0.00001; I2 = 0%), and body movement (OR, 3.51; 95% CI, 2.03–6.09; P<0.00001; I2 = 0%) were significantly increased in the propofol-based total intravenous anesthesia and the duration of operation were longer in the Group Prop. Compared with the control ventilation group , the incidences of laryngospasm (OR, 0.16; 95% CI, 0.05–0.56; P=0.004; I2 = 54%), apnea (OR, 0.21; 95% CI, 0.09–0.50; P=0.0004; I2 = 0%), and cough/bucking (OR, 0.03; 95% CI, 0.01–0.10; P<0.00001; I2 = 41%) increased in the spontaneous ventilation group and the duration of operationand emergence from anesthesia significantly prolonged in the Group SV. Conclusions: Our meta-analysis suggests that sevoflurane-based volatile anesthesia was superior to propofol-based total intravenous anesthesia for the management of foreign body aspiration in children. There is still no strong evidence indicated that one ventilation technique was superio


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O M T Al-Safty ◽  
O R Youssef ◽  
D M Kamaleldin ◽  
M K M Youssef

Abstract Background Foreign body aspiration is a life-threatening condition. Asphyxiation from inhaled foreign bodies is a leading cause of accidental death among children younger than 4 years. While early clinicians used topical anesthesia, general anesthesia became common place for the removal of aspirated objects with increased experience with the rigid bronchoscope and advances in anesthetic delivery. Inhaled anesthesia and total intravenous anesthesia are widely used for rigid bronchoscopy in children. Objective In this study, we compared sevoflurane VIMA and propofol TIVA, when used for both induction and maintenance of anesthesia in children undergoing rigid bronchoscopy for tracheal or bronchial foreign body removal. Methods This is a prospective double – blinded, randomized controlled Trial, After Approval is obtained from the research ethics committee of anaesthesia and intensive care department, Ain Shams University. Patients were randomly divided into two groups (n = 30 each). In Group VIMA, anesthesia was induced with inhalation of sevoflurane. Before induction, a closed circuit with a 1-l reservoir bag was overflowed by 8 vol % sevoflurane with 0.3 l/min fresh oxygen flow for 3 min. In Group TIVA, a bolus of 2.5 mg/kg propofol was administered over 30 seconds. Additional propofol 0.5–1 mg/kg was given as needed to deepen anesthesia. Results Our results demonstrate that compared with propofol TIVA, sevoflurane VIMA provides more stable haemo-dynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal. Conclusion Foreign body aspiration is a life-threatening condition. Anesthetic management can be challenging, as the airway is shared with the surgeon and adequate ventilation must be maintained despite airway manipulation.


Author(s):  
Sagar Jawale ◽  
Parthapratim Gupta ◽  
Bharti Kulkarni

<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>


2009 ◽  
Vol 109 (4) ◽  
pp. 1079-1084 ◽  
Author(s):  
Lian-hua Chen ◽  
Xu Zhang ◽  
Shao-qin Li ◽  
Yu-qi Liu ◽  
Tian-yu Zhang ◽  
...  

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