A large foreign body in the bronchus: Anaesthetic and Surgical Challenges

Abstract

Purpose: Sharing the airway with the surgeon and maintaining oxygenation during the removal of a large tracheal or bronchial foreign body (FB) can be challenging. We report the unusual extraction of a large foreign body and the anaesthetic challenges encountered during its removal. Clinical features: A 9 month old baby presented to the emergency department with respiratory distress. Xray chest revealed partial collapse of right lung with mediastinal shift and hyperinflation of left lung. The patient was taken to the operating room for emergency bronchoscopy. Bronchoscopy was done after inhalational induction with sevoflurane. The anaesthetic technique was spontaneous ventilation using isoflurane and intermittent doses of propofol. The surgeon was unable to extract the foreign body due to its large size. After multiple attempts and dislodgement of the FB to the opposite side with severe desaturation, a decision to do tracheotomy was made to extract the FB. The technique of anaesthesia involved changing over from spontaneous to controlled ventilation and endotracheal intubation for immediate management of desaturation. The FB was successfully removed through a tracheotomy with no further adverse events. Conclusion: Complete cooperation and good communication between the surgeon and the anaesthesiologist is very important for the successful outcome of bronchoscopic procedures. When the surgeon has difficulty in extracting the foreign body, due to its large size they may have to resort to methods of removal other than through the oral cavity. Anaesthesiologist may have to alter one's planned technique and be ready to take quick measures in times of unexpected incidents.