Anesthesia for tracheobronchial foreign bodies removal via self-retaining laryngoscopy and Hopkins telescopy in children

The characteristics of foreign bodies aspirated by children across different continents: A comparative review

BACKGROUND

Foreign body aspiration (FBA) is a common issue in pediatric emergencies, with regional variations. Various cultures and foods, parents' and physicians' inadequate experience, and lack of bronchoscopy equipment are some attributable factors in the regional variation of FBA.

AIM

To more accurately represent the demographic characteristics of aspirated foreign bodies (FBs) across various continents, this review attempted to provide organized information based on the reviewed articles.

METHODOLOGY

A search was conducted in PubMed/PubMed Central, EMBASE, and google scholar. From the 36 included articles, information on age, gender, bronchoscopy type, type of FB, location, history of choking, and time elapsed between aspiration and admission were extracted.

RESULTS

A total of 14,469 cases were evaluated. According to the findings, children under two accounted for more than 75% of FBAs. Nuts and seeds were the most common FBs in most countries, whereas plastic and metal objects had higher rates in Brazil, and calcified objects were more prevalent in Thailand. The right bronchus was the most frequent location, and rigid bronchoscopy was the most often utilized type of bronchoscope. In addition, a significant percentage of patients were referred to the emergency rooms in the first 12-24 h following the aspiration incident. Moreover, Asian patients reported more choking history, and Europeans had fewer witnesses of FBA.

CONCLUSIONS

There is a lack of standardized reporting systems and organized guidelines in pediatric FBA. To select the ideal time for endoscopies and create educational programs, a collaboration between experienced researchers, pediatric pulmonologists, radiologists, and otolaryngologists is required.

Entrapment of a laryngotracheal topical anesthesia kit during tracheobronchial foreign body removal: a case report

Background

In order to reduce the irritation of the airway during tracheobronchial foreign body (TFB) removal, tracheal surface anesthesia is usually performed using a laryngotracheal topical anesthesia (LTA) kit (LTA20, Highgreen Medical Technology Company, China), but difficulty in withdrawing the LTA kit is rarely reported. We present a case of a difficulty to withdraw the LTA kit due to its entrapment by the movement of a TFB.

Case presentation

A 1-year-old girl was undergoing TFB removal. After the surgeon completed the tracheal surface anesthesia, the girl suddenly suffered from bucking, leading to the dislodgment of the TFB to the subglottic region, complicating the withdrawal of the LTA applicator. At the same time, the girl’s oxygen saturation (SpO₂) decreased to 91% and her heart rate dropped from 150 to 100 bpm. Atropine and succinylcholine were administered intravenously immediately, then the surgeon tried to free the TFB by pushing it back into the trachea, after which the LTA applicator was easily withdrawn, and TFB was removed successfully. The girl was discharged from hospital without any complications 2 days later.

Conclusion

This case report draws our attention to a significant anesthetic clinical consideration during the application of topical anesthesia on the trachea for TFB removal. The possibility of coughing or bucking can lead to migration of the TFB with subsequent airway obstruction, so the depth of anesthesia must be sufficient to prevent harmful reflexes. Also, strong teamwork and good communication are paramount to avoid serious complications.

Controlled ventilation or spontaneous respiration in anesthesia for tracheobronchial foreign body removal: a meta-analysis

BACKGROUND

Either controlled ventilation or spontaneous respiration is commonly used in general anesthesia for inhaled foreign body removal via rigid bronchoscopy. Controversy in the literature exists concerning which form of ventilation is optimally suited for bronchoscopy. We performed a meta-analysis to compare controlled ventilation and spontaneous respiration with respect to complications, operation time, and anesthesia recovery time.

METHODS

We searched MEDLINE (1946-2013) and the Cochrane Central Register of Controlled Trials, EMBASE. The articles were evaluated for validity, and the data on complications, including desaturation, laryngospasm, laryngeal edema, bucking and coughing, body movement, breath holding, operation time, and anesthesia recovery time, were extracted by the authors and summarized using odds ratios, mean differences, and 95% confidence intervals (CIs).

RESULTS

From the included studies, 423 subjects received controlled ventilation, whereas 441 subjects received spontaneous respiration. There was no significant difference in the incidence of desaturation between controlled ventilation and spontaneous respiration (odds ratio, 0.70; 95% CI, 0.30-1.63). However, the incidence of laryngospasm was lower when controlled ventilation was performed (OR, 0.27; 95% CI, 0.10-0.76). The operation time (mean difference, -9.07 min; 95% CI, -14.03 to -4.12) was shorter in the controlled ventilation group.

CONCLUSIONS

Current evidence does not show a preference for either controlled ventilation or spontaneous respiration, although laryngospasm has a lower incidence when controlled ventilation is performed. Additional clinical studies are required to substantiate this issue.