A retrospective analysis on anesthetic management during rigid bronchoscopy in children with foreign body aspiration: Propofol and sevoflurane with controlled ventilation

Aspiration of a foreign body is a potentially life-threatening problem that often necessitates an anesthetic for removal of the foreign body. Foreign body aspiration is most common among children aged 1 to 4 years old and has a wide variety of symptoms ranging from a mild, nagging cough to complete airway obstruction. Definitive diagnosis and treatment of foreign body aspiration involve flexible or rigid bronchoscopy. The urgency of the procedure depends on the type of object aspirated and the location of the foreign body in the airway. The appropriate anesthetic for removal of the foreign body is dependent upon the surgeon’s plan and involves several steps in decision-making: intravenous versus inhalational induction, airway maintenance (endotracheal tube vs. supraglottic airway vs. mask), spontaneous versus controlled ventilation, maintenance of anesthesia (total intravenous anesthesia vs. volatile agents). Good communication with the surgeon or proceduralist is key to a safe and effective anesthetic.

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Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.1225 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Erol Karaaslan ◽

Turan Yıldız

Keyword(s):

Intensive Care ◽

Foreign Body ◽

Anesthetic Management ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Laryngeal Edema ◽

Postoperative Intensive Care ◽

Operative Complications ◽

Tracheobronchial Foreign Body ◽

Post Operative Complications

Objectives: Delayed diagnosis and treatment of tracheobronchial foreign body aspiration (FBA) in children may lead to morbidity and mortality. Our objective was to evaluate the anesthetic management, peri- and post-operative complications, and predisposing factors for postoperative intensive care unit (ICU) admission in children undergoing rigid bronchoscopy due to tracheobronchial FBA. Methods: This retrospective study included 81 children who underwent rigid bronchoscopy between January 2010 to July 2018 at Inonu University, Department of Pediatric Surgery, Turkey. Data regarding demographic characteristics, anesthetic management, length of ICU and hospital stays, and peri- and post-operative complications were retrieved from the hospital database. Results: The patients included 54 (66.7%) boys and 27 (33.3%) girls with a mean age of 29.6±31.2 months. The most common presenting symptom was the suspicion of FBA, followed by acute-onset cough, cyanosis, wheezing and respiratory distress. Mean duration of anesthesia was 44.40±14.72 min. Of the 81 patients, 18 (22.2%) were transferred to ICU and 63 (77.8%) patients were transferred to the ward postoperatively. Of the patients transferred to the ICU, 5 of them required mechanical ventilation. Some peri and postoperative complications, desaturation (n=16; 19.7%; p=0.001), mucosal bleeding (n=6; 7.4%; p=0.02), laryngeal edema (n=11; 13.6%; p<0.001), laryngospasm (n=13; 16.3%; p<0.001), were affected the frequency of intensive care transfer. Conclusion: Bronchoscopy with general anesthesia remains the golden standard for the management of tracheobronchial FBA. In such patients, a combination consisting of a detailed preoperative clinical evaluation of the patient, selection of short-acting anesthetic agents with minimal side effects for the induction and maintenance of anesthesia, and the administration of controlled ventilation can be recommended. Additionally, early diagnosis of peri- and post-operative complications, prediction of postoperative ICU requirement, and a close cooperation of anesthesiologists and surgeons are highly important. doi: https://doi.org/10.12669/pjms.35.6.1225 How to cite this:Karaaslan E, Yildiz T. Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration. Pak J Med Sci. 2019;35(6):1592-1597. doi: https://doi.org/10.12669/pjms.35.6.1225 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A comparison between Sevoflurane Volatile Induction/Maintenance Anesthesia and Propofol Total Intra-venous Anesthesia for Rigid Bronchoscopy under Spontaneous Breathing for Tracheal/Bronchial Foreign Body Removal in Children

QJM ◽

10.1093/qjmed/hcaa039.011 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O M T Al-Safty ◽

O R Youssef ◽

D M Kamaleldin ◽

M K M Youssef

Keyword(s):

Foreign Body ◽

Controlled Trial ◽

Anesthetic Management ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Body Removal ◽

Bronchial Foreign Body ◽

Threatening Condition ◽

Life Threatening ◽

Double Blinded

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.

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

BMC Surgery ◽

10.1186/s12893-021-01089-3 ◽

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.

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

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192746 ◽

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

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.

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A gyermekkori alsó légúti idegentest-aspiráció diagnosztikája a klinikai gyakorlatban

Orvosi Hetilap ◽

10.1556/650.2018.31165 ◽

2018 ◽

Vol 159 (51) ◽

pp. 2162-2166

Author(s):

Dániel Hajnal ◽

Tamás Kovács

Keyword(s):

Foreign Body ◽

Standard Procedure ◽

False Negative ◽

Radiological Finding ◽

Paediatric Population ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

X Ray ◽

Co Morbidity ◽

Chest X Ray

Abstract: Introduction and aim: Rigid bronchoscopic foreign body removal is the gold standard procedure for foreign body aspiration. We have analysed our results of bronchoscopies and the accuracy of diagnosis among the paediatric population in Southeast Hungary. Method: A retrospective study of children admitted because of suspected solid foreign body aspiration between 2006 and 2017 was performed. Results: From among 220 admitted patients, 86 were suspected of solid particle aspiration. Presenting history was certain in 68.6% (n = 59/86). Sudden choking-like symptoms were present in 61/86 patients (70.9%), coughing in 81/86 patients (94.2%). Thoracic auscultation was positive in 67/86 cases (77.9%), chest X-ray in 75/86 patients (87.2%), while fluoroscopy only in 12/75 cases (16%). 92 bronchoscopies in 86 patients were performed. In 57 bronchoscopies, solid foreign body was found (66.2%) and the removal was successful in 56 cases. Thoracic auscultation was negative in patients with foreign body only in 6/57 cases (10.5%). In the same group, chest X-ray was negative in 33/57 cases (57.9%) and fluoroscopy was positive only in 12/57 patients (21.1%). Pneumonia or prolonged bronchitis was present in 4/86 patients (4.6%). Severe bronchial bleeding occurred in 2/86 cases (2.3%). Mortality was 1.2%, a child with severe co-morbidity and chronic aspiration passed away. Bronchoscopy was negative in 29/86 patients (33.7%). Complications were significantly higher in chronic cases than in the acute ones. Conclusion: Rigid bronchoscopy is indicated if solid foreign body aspiration is suspected and positive anamnesis, typical symptoms (coughing, choking) or positive chest auscultations are present. Diagnosis predominantly based on radiological finding is controversial due to the high possibility of false negative results. Early intervention within the first 24 hours is recommended to avoid complications. Orv Hetil. 2018; 159(51): 2162–2166.

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Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002837 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1078-1083 ◽

Cited By ~ 15

Author(s):

G Behera ◽

N Tripathy ◽

Y K Maru ◽

R K Mundra ◽

Y Gupta ◽

...

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Multidetector Computed Tomography ◽

Diagnostic Tool ◽

Foreign Bodies ◽

Three Dimensional ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Virtual Bronchoscopy

AbstractObjectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

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Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194925 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1552

Author(s):

Kunzes Dolma ◽

Anchal Gupta ◽

Apurab Gupta ◽

Padam Singh Jamwal

Keyword(s):

Foreign Body ◽

Clinical Examination ◽

Foreign Bodies ◽

Standard Procedure ◽

Neck Surgery ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Female Ratio ◽

Mortality And Morbidity ◽

Delay In Diagnosis

Background: The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.Methods: The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied. Results: The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.Conclusions: History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies.

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Concealed Foreign Body Aspiration: A Master of Disguise

Malaysian Journal of Paediatrics and Child Health ◽

10.51407/mjpch.v26i1.3 ◽

2020 ◽

Vol 26 (1) ◽

pp. 29-32

Author(s):

Pravin Sugunan ◽

Netia Jeganathan ◽

Philip Rajan Devesahayam

Keyword(s):

Mechanical Ventilation ◽

Foreign Body ◽

Respiratory Distress ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Rapid Recovery ◽

School Age Children ◽

School Age

Aspiration of a foreign body is rare in school-age children. This reports the 21-day journey of an 8-year-old girl who had a foreign body aspiration. She presented to our hospital after five days of respiratory distress. She subsequently required mechanical ventilation and was supported with triple inotropes. After 18 days, a foreign body was removed via rigid bronchoscopy, followed by a rapid recovery of the patient.

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Urgent bronchoscopy for foreign body aspiration: 48 children among 1096 patients

Acta Medica ◽

10.32552/2019.actamedica.359 ◽

2019 ◽

Vol 50 (3) ◽

pp. 38-43

Author(s):

Alper Avcı ◽

Onder Ozden ◽

Zehra Hatipoglu ◽

Serdar Onat

Keyword(s):

Foreign Body ◽

Postoperative Complications ◽

Oxygen Saturation ◽

English Literature ◽

Length Of Hospital Stay ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Peripheral Oxygen Saturation ◽

Life Saving ◽

Life Threatening

Objective: Foreign body aspiration (FBA) is a potentially life-threatening emergency in children. Urgent rigid bronchoscopy (URB) should be performed when presentation includes severe respiratory failure with suspicion for FBA. To the best of the knowledge, this is the first study that evaluates URB in English literature. Methods: Forty-eight patients who underwent URB were included in this study. From the medical records, the patients’ demographic characters, endotracheal intubation status, peripheral oxygen saturation, bronchoscopy results, type and location of foreign body (FB), intra- and postoperative complications and mortality, X-ray, length of hospital stay were evaluated. Results: Twenty-four of the 48 patients were non-intubated. Peripheral oxygen saturation values were 60 ± 14.40 in the preoperative period. No statistical differences were found between intubated and non-intubated patients in terms of intra- and postoperative complications. There were no statistical differences between patients with negative and positive results for bronchoscopy in terms of intra- and postoperative complications. Conclusions: Bronchoscopy is not without risk; however, it is a life-saving procedure. Despite negative FB results, urgent bronchoscopy should be performed in suspicious cases.

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