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

Abstract

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.

Pediatrik olgularda uygulanan rijit bronkoskopi işleminde anestezi derlemesinde sugammadeks ve neostigminin etkinliğininin karşılaştırılması

“…[11][12] Cough, shortness of breath, hoarseness and wheezing in the first period are among the reasons for admission to FBA; obstructive emphysema, lung abscess, atelectasis, empyema, pneumothorax, and bronchiectasis can be seen among the late-term findings. 5,13,14 In our study, we encountered the most common complaints of cough, shortness of breath and bruising. The mean age of patients was 3.3…”

Anesthesia for thoracic surgery in infants and children

“…After induction, an inhalational technique with sevoflurane may be supplemented as needed with propofol, ketamine, or dexmedetomidine. [ 87 88 89 ] Alternatively, a total intravenous approach may be employed. [ 86 90 91 92 93 ] Neuromuscular blockade and controlled ventilation are preferable in situations in which patient movement could cause severe complications, such as balloon dilation of a stenotic lesion, laser-assisted procedures, or even during foreign body removal.…”

“…[ 86 90 91 92 93 ] Neuromuscular blockade and controlled ventilation are preferable in situations in which patient movement could cause severe complications, such as balloon dilation of a stenotic lesion, laser-assisted procedures, or even during foreign body removal. [ 85 88 94 ]…”

Çocuklarda Yabancı Cisim Aspirasyonu; Düzce Üniversitesi Beş Yıllık Sonuçlar

“…Foreign body aspiration is defined as the aspiration of a foreign body into the tracheobronchial tree (1). As the result of inhalation of materials such as foods, toys, bones, seeds occur acute-onset upper respiratory airway obstruction.…”