The Anesthetic Considerations of Tracheobronchial Foreign Bodies in Children
Top Cited Papers
- 1 October 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 111 (4), 1016-1025
- https://doi.org/10.1213/ane.0b013e3181ef3e9c
Abstract
Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years. We analyzed the recent epidemiology of foreign body aspiration and reviewed the current trends in diagnosis and management. In this article, we discuss anesthetic management of bronchoscopy to remove objects. The reviewed articles total 12,979 pediatric bronchoscopies. Most aspirated foreign bodies are organic materials (81%, confidence interval [CI] = 77%-86%), nuts and seeds being the most common. The majority of foreign bodies (88%, CI = 85%-91%) lodge in the bronchial tree, with the remainder catching in the larynx or trachea. The incidence of right-sided foreign bodies (52%, CI = 48%-55%) is higher than that of left-sided foreign bodies (33%, CI = 30%-37%). A small number of objects fragment and lodge in different parts of the airways. Only 11% (CI = 8%-16%) of the foreign bodies were radio-opaque on radiograph, with chest radiographs being normal in 17% of children (CI = 13%-22%). Although rigid bronchoscopy is the traditional diagnostic "gold standard," the use of computerized tomography, virtual bronchoscopy, and flexible bronchoscopy is increasing. Reported mortality during bronchoscopy is 0.42%. Although asphyxia at presentation or initial emergency bronchoscopy causes some deaths, hypoxic cardiac arrest during retrieval of the object, bronchial rupture, and unspecified intraoperative complications in previously stable patients constitute the majority of in-hospital fatalities. Major complications include severe laryngeal edema or bronchospasm requiring tracheotomy or reintubation, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage (0.96%). Aspiration of gastric contents is not reported. Preoperative assessment should determine where the aspirated foreign body has lodged, what was aspirated, and when the aspiration occurred ("what, where, when"). The choices of inhaled or IV induction, spontaneous or controlled ventilation, and inhaled or IV maintenance may be individualized to the circumstances. Although several anesthetic techniques are effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. An induction that maintains spontaneous ventilation is commonly practiced to minimize the risk of converting a partial proximal obstruction to a complete obstruction. Controlled ventilation combined with IV drugs and paralysis allows for suitable rigid bronchoscopy conditions and a consistent level of anesthesia. Close communication between the anesthesiologist, bronchoscopist, and assistants is essential.Keywords
This publication has 69 references indexed in Scilit:
- Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995–2006Surgical Endoscopy, 2008
- Relationship between age and spontaneous ventilation during intravenous anesthesia in childrenPediatric Anesthesia, 2007
- Use of Decubitus Radiographs in the Diagnosis of Foreign Body Aspiration in Young ChildrenPediatric Emergency Care, 2007
- Evaluation of clinical, radiologic, and laboratory prebronchoscopy findings in children with suspected foreign body aspirationJournal of Pediatric Surgery, 2006
- Total contralateral atelectasis following rigid bronchoscopy in a child with scarf pin aspirationPediatric Anesthesia, 2006
- Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removalPediatric Anesthesia, 2006
- Anesthesia for removal of inhaled foreign bodies in childrenPediatric Anesthesia, 2005
- Anesthesia for removal of inhaled foreign bodies in childrenPediatric Anesthesia, 2004
- Near-fatal grape aspiration with complicating acute lung injury successfully treated with extracorporeal membrane oxygenationPediatric Critical Care Medicine, 2003
- Management of tracheobronchial and esophageal foreign bodies in children: A survey studyJournal of Clinical Anesthesia, 1994