Laryngeal mask airway for ventilation during interventional flexible bronchoscopy in children

Abstract

Interventional flexible bronchoscopy in children usually requires its realization under general anesthesia. In our practice, we use this type of endoscopy for foreign body removal or for extraction of casts of plastic bronchitis using a pediatric flexible bronchoscope (3.6 mm diameter) inserted through a tracheal tube of at least 4.5 mm diameter. Compared to the adult flexible bronchoscope, Pediatric bronchoscope has a smaller internal diameter, a lower suction pressure and does not allow use of large forceps able to remove bronchial foreign bodies effectively. Recently, we have successfully used adult flexible bronchoscope (4.9 mm diameter) through a laryngeal mask in children aged between 1.5 and 4 years for distal foreign body removal and for the extraction of bronchial casts. Foreign bodies were surrounded by a granulomatous mucosa and the extraction attempt with the pediatric flexible bronchoscope failed. No complications occurred with the laryngeal mask. Laryngeal mask airway is a safe and effective adjunct to flexible bronchoscopy under general anesthesia in children. Compared with a tracheal tube, it allows the use of larger flexible bronchoscope. Its use in foreign body removal may avoid surgery in many children with foreign body aspiration.