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.
Highlights
Tracheobronchial foreign body aspiration (FBA) is the aspiration of a foreign body (FB) into the tracheobronchial tree through the mouth or nose during inhalation and is the most common cause of acuteonset upper respiratory airway obstruction
80% of tracheobronchial FBA cases are seen in children aged 0-3 years and tracheobronchial FBA is responsible for 0-1.8% of deaths in this age group
The most common presenting symptom was the suspicion of FBA, followed by acute-onset cough, cyanosis, wheezing, respiratory distress, nauseavomiting, and pneumonia
Summary
Tracheobronchial foreign body aspiration (FBA) is the aspiration of a foreign body (FB) into the tracheobronchial tree through the mouth or nose during inhalation and is the most common cause of acuteonset upper respiratory airway obstruction. 80% of tracheobronchial FBA cases are seen in children aged 0-3 years and tracheobronchial FBA is responsible for 0-1.8% of deaths in this age group. FBA is the most common cause of accidental deaths in children less than one-year-old.[1,2]. Given the shared use of the airway by the surgeon and the anesthesiologist, bronchoscopy requires experienced teams for securing sufficient ventilation and oxygenation in the patient.[4] Anesthetic managements during bronchoscopic procedures, the anesthetic technique to be used, is of prime importance due to the risk of peri- and postoperative complications. Successful anesthetic management and removal of an aspirated FB has a contributory effect on the reduction of morbidity and mortality.[5,6]
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