Bronchoscopy For Foreign Body Removal Research Articles

Hypoxaemia risk in pediatric flexible bronchoscopy for foreign body removal: a retrospective study

BackgroundHypoxemia represents the most prevalent adverse event during flexible bronchoscopy procedures aimed at foreign body retrieval in pediatric patients; if not expeditiously managed, it carries the potential for cardiac or respiratory arrest. The specific risk factors contributing to the occurrence of hypoxemia during foreign body FB removal via bronchoscopy have yet to be definitively established.MethodsThis retrospective study included a cohort of 266 pediatric subjects from January 1, 2015, to December 31, 2022, who underwent flexible bronchoscopy for the purpose of FB extraction. In this cohort, the supraglottic airway was used to connect the anesthesia apparatus during the removal procedure.ResultsIn total, 45 of the pediatric patients (16.9%) experienced episodes of hypoxemia during the FB removal procedure. Multivariate analysis revealed that the following factors were significantly associated with the occurrence of hypoxemia: an operation time exceeding 60 min (odds ratio [OR] 8.55; 95% confidence interval [CI] 3.82–19.13), a maximum diameter exceeding 7 mm (OR 5.03; 95% CI, 2.24–11.29), and the presence of radiological evidence indicating pneumonia (OR 2.69; 95% CI, 1.27–5.69).ConclusionDuring flexible bronchoscopy procedures aimed at FB removal in pediatric patients, there is an increased susceptibility to hypoxemia. Factors including extended operation duration, larger FB dimensions, and radiographic evidence suggestive of pneumonia significantly contribute to a heightened risk of hypoxemia.

Fluoroscopy-guided metallic foreign body removal: A case report

A foreign body (FB) was detected in the right lower zone on the chest X-ray of a 24-year-old woman who presented to the OPD with a cough and sputum. With the help of virtual bronchoscopy, the FB was localized in the posterior segment of the right lower lobe. It was located with the help of a flexible bronchoscope and fluoroscopy and retrieved with the help of snare and endobronchial biopsy forceps. After ensuring clinical stability, the patient was discharged the next day. Bronchoscopic FB removal from segmental and subsegmental bronchi is difficult. Fluoroscopy permits the bronchoscopic retrieval of FB from these relatively inaccessible regions and of the lung and averts the need for thoracotomy.

Use of Flexible Bronchoscopy in Foreign Body Aspiration.

Objective:Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic.Methods:We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis.Results:Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients.Conclusion:Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children.

Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience.

(1) To study the epidemiological profile of the patients. (2) To study the various modalities of investigations to arrive at confirmatory diagnosis. (3) To study the post-operative complications. It was a hospital based prospective study. A total of 36 paediatric patients were included in the study over a duration of 2years (August 2017 to July 2019). Written informed consent was taken from the parent of each patient before performing bronchoscopy. All the patients were subjected to careful clinical examination and investigations required followed by emergency bronchoscopic removal of foreign body. The patients were followed up at 1 and 3months after bronchoscopic removal. Amongst the 36 cases, 12 cases presented with airway emergency which addressed by bronchoscopic removal immediately. 10 cases presented with suggestive history of foreign body aspiration were subjected to clinical and radiological studies followed by bronchoscopic removal. 14 cases were referred from paediatric in-patient department who were being treated for unresolved LRTI. Early intervention is life saving if timely done. Unresolved LRTIs should be looked carefully to address missed foreign bodies. HRCT Thorax with 3-D reconstruction (Virtual Bronchoscopy) helps in exact localization of the foreign body. Experienced team of surgeons and anesthetist along with a ICU support is needed for efficient management.

Higher doses of fentanyl during bronchoscopy in infants significantly reduces perioperative complication rates

ObjectivesThe specific aim of this study was to assess the effect of higher fentanyl doses on reducing perioperative complication rates among infants undergoing rigid bronchoscopy. MethodsSixty children who underwent rigid bronchoscopy for foreign body removal were enlisted in our 2-year prospective cohort study at the Department of ENT and Head & Neck Surgery, Medical University – Sofia. Infants were randomly distributed into two groups according to fentanyl dose (group 1 - 1–2 μg/kg vs group 2 - 6–7 μg/kg). Hemodynamic parameters and perioperative complications were recorded. ResultsThe mean age of the whole study group was 1.94 years. Five minutes prior to anesthesia both groups presented with similar parameter levels and no statistically significant difference was found. In contrast, at 5th and 10th minutes after intubation the heart rate, systolic and diastolic blood pressure levels were recorded at significantly higher levels in group 1 compared to group 2 (p = .000). Same results were obtained five minutes after extubation. Additionally, after performing the Pearson chi-Square test we found that bronchospasm and laryngospasm were significantly more frequent among patients from group 1 infused with lower dosage of fentanyl in comparison to the infants that were administered with a higher dose of this medication (p = .020). Phi and Cramer's V tests both display moderate strength of this association (V = 0.302). ConclusionIn the current study we propose refinement of current anesthetic protocols by using higher doses of fentanyl during rigid bronchoscopy in infants. This significantly reduces perioperative complication rates and improves intraoperative hemodynamics without presenting any newly formed risks.

Tension Pneumothorax -Challenge of foreign body removal during Rigid Bronchoscopy in children

Rigid bronchoscopy for foreign body removal from lungs can cause life threatening complications like tension pneumothorax. A timely diagnosis and active management can prevent devastating events. A two years old child who developed tension pneumothorax after rigid bronchoscopy for foreign body removal was survived successfully because of multidisciplinary active management.

Insurance type impacts bronchoscopy for foreign body aspiration: An analysis of the Kids’ Inpatient Database

ObjectivesTo ascertain whether insurance type is associated with postoperative adverse effects and hospital length of stay for inpatient airway foreign body removal. MethodsRetrospective analysis of children <18 years of age that underwent inpatient bronchoscopy with removal of airway foreign body in the national Healthcare Cost and Utilization Project Kid's Inpatient Database (KID). Postoperative outcomes and length of stay were analyzed for racial disparities and insurance type using multivariable logistic regression and negative binomial regression. Models adjusted for race, insurance type, sex, age, and presence of pulmonary risk factors. ResultsA total of 5,850 children underwent bronchoscopy for foreign body removal. The median age was 2 (IQR: 4–1) years and 61.6% patients were male. Payer status included Medicaid (38.9%), private insurance (51.5%), self-pay (4.3%) and other (9.6%). The Medicaid cohort had a higher proportion of black (19.1%) and Hispanic patients (34.5%) (P < 0.001). Children covered under Medicaid had higher odds of postoperative complications (odds ratio [OR] 1.216; P = 0.031) and a greater length of stay (OR 1.533; P < 0.001) relative to the private insurance group when adjusting for sex, age, race and presence of pulmonary risk factors. The odds of having a greater length of stay was 33% higher for black (P < 0.001) and 37% higher for Hispanic (P < 0.001) children compared to white children. The average adjusted LOS under Medicaid was 8.37 days compared to 5.46 days for privately insured children. ConclusionThis study demonstrated that a difference in postoperative complications and LOS exist between public and privately insured children for foreign body removal via bronchoscopy. Further studies are warranted to investigate factors that drive these disparities.

Pediatric surgery during coronavirus disease lockdown

Background: Coronavirus disease Pandemic has affected the health-care delivery at all institutions worldwide. Analysis of multi-institutional data would reflect the impact and challenges of this pandemic in managing pediatric surgical cases. To assess the impact of lockdown due to coronavirus disease 2019 (COVID-19) on the pediatric surgical cases operated at four tertiary care institutions. Materials and Methods: Retrospective data of all patients operated at four tertiary care centers in North India in three different states during the imposition of lockdown due to COVID-19 were collected and compared to the immediate prelockdown period. The impact of following the guidelines for surgery during this period was studied. Results: All the institutions involved in the study showed a significant fall in the number and nature of patients treated during the lockdown period when compared to the prelockdown data. No elective cases were operated; 100 children were operated during this period of which neonates (56%) formed the major group; most of them were cases of congenital anomalies which could not be deferred; solid tumours (3/100) were operated on semi-emergency basis; number of trauma patients fell down drastically (1/100); one patient had bronchoscopic foreign body removal; other patients were operated for different causes of acute abdomen. Several measures in the outpatient, intraoperative, and in-patient care were adopted to lessen the spread of virus to the patient and health-care team. Conclusion: Corona pandemic severely impacted both the number and types of patients operated. Strict adherence to the protocol delayed emergency treatment and increased the cost of definitive management.

An unusual case of a tracheobronchial foreign body

We herein report a case of an unusual tracheal foreign body in a 42-year-old patient who after having undergone surgery for a tongue base malignancy presented following discharge with progressively worsened intractable cough. A chest x ray revealed a foreign body (FB) extending from glottis through the trachea up to the right bronchi. Awake fiberoptic bronchoscopic FB removal was done and the tube was recovered as a whole delivered through the oral cavity. It was 2/3rd the length of an airway exchanger catheter (AEC) used during the trial of extubation.

Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies. &lt;/p&gt;

Flexible Bronchoscopic Removal of Foreign Bodies from Airway of Children: Single Center Experience Over 12 Years

To report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode. Hospital records of tracheobronchial foreign body extractions between January, 2006 and January, 2018 were reviewed. Clinical presentations, radiological findings, location and types of tracheobronchial foreign bodies, types of bronchoscopes, complications and outcome of the procedures were analyzed. 283 extractions in children with median (range) age of 18 (5-168) months were reviewed. Extraction by flexible bronchoscope, using wire baskets or grasping forceps, was successful in 260 cases. No major complications were encountered. Mean (SD) time for the procedure was 31 (6.3) minutes. Airway foreign bodies can safely be removed by flexible bronchoscopy with minimal complications. This procedure can be considered the primary mode for removal of airway foreign bodies by a trained and experienced person.

Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

&lt;p&gt;Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Foreign body aspiration of the lower airways in children - diagnosis in clinical practice

Rigid bronchoscopic foreign body removal is the gold standard procedure for foreign body aspiration. We have analysed our results of bronchoscopies and the accuracy of diagnosis among the paediatric population in Southeast Hungary. A retrospective study of children admitted because of suspected solid foreign body aspiration between 2006 and 2017 was performed. From among 220 admitted patients, 86 were suspected of solid particle aspiration. Presenting history was certain in 68.6% (n = 59/86). Sudden choking-like symptoms were present in 61/86 patients (70.9%), coughing in 81/86 patients (94.2%). Thoracic auscultation was positive in 67/86 cases (77.9%), chest X-ray in 75/86 patients (87.2%), while fluoroscopy only in 12/75 cases (16%). 92 bronchoscopies in 86 patients were performed. In 57 bronchoscopies, solid foreign body was found (66.2%) and the removal was successful in 56 cases. Thoracic auscultation was negative in patients with foreign body only in 6/57 cases (10.5%). In the same group, chest X-ray was negative in 33/57 cases (57.9%) and fluoroscopy was positive only in 12/57 patients (21.1%). Pneumonia or prolonged bronchitis was present in 4/86 patients (4.6%). Severe bronchial bleeding occurred in 2/86 cases (2.3%). Mortality was 1.2%, a child with severe co-morbidity and chronic aspiration passed away. Bronchoscopy was negative in 29/86 patients (33.7%). Complications were significantly higher in chronic cases than in the acute ones. Rigid bronchoscopy is indicated if solid foreign body aspiration is suspected and positive anamnesis, typical symptoms (coughing, choking) or positive chest auscultations are present. Diagnosis predominantly based on radiological finding is controversial due to the high possibility of false negative results. Early intervention within the first 24 hours is recommended to avoid complications. Orv Hetil. 2018; 159(51): 2162-2166.

Factors Influencing Prognosis in the Endoscopic Extraction of Foreign Bodies in Kashmiri Population

An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.

DIFFICULT BRONCHOSCOPIC EXTRACTION OF MULTIPLE ASPIRATED TEETH AS A RESULT OF HEAD INJURY AFTER ACUTE MYOCARDIAL INFARCTION LEADING TO MOTOR VEHICLE ACCIDENT

SESSION TITLE: Allergy and Airway SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tracheobronchial foreign body aspiration(FBA) in adults is common requiring early recognition to prevent potential complications. Presentation may be subtle, particularly if there are other confounding clinical factors, and requires a high index of suspicion(1). Atelectasis, air trapping, pulmonary infiltrates, and mediastinal shift may be the initial signs of FBA. A common setting is loss of consciousness with trauma, intoxication or neuological disease(1). Delay in diagnosis can be life-threatening, with occlusion of the large airways, potential asphyxiation, pneumonia and abscess,and delayed sepsis(2). Over 90% of foreign bodies are radiolucent and teeth are fortunately radiodense. The right bronchus is the most common site of FBA vs. the distal airways, and are rarely bilateral as in this case. This case report reveal tricks via FB for retrieval of multiple, distally impacted teeth. CASE PRESENTATION: We report a case of FBA in a 64-year-old man who lost consciousness after an acute myocardial infarction, who hit his head on the steering wheel developed a a subarachnoid haemorrhage in a motor vehicle accident(MVA). He was hemodynamic stable with GCS 8/15. It was noted he had lost several teeth. CXR demonstrated bilateral lower lobe hyperlucencies(Figure 1A). CT chest confirmed one tooth in the right lower(Figure 1B) and two in the left lower lobe(Figure 1C, D).FB was performed through the ETT, retrieving three aspirated teeth(Figure 2A). The small, smooth hard nature of the teeth thwarted initial attempts for retrieval with alligator forceps. Multiple adjunctive techniques were employed, including enclosing the teeth with various retrieval devices using a Roth net(Figure 2B,C) and Dormia basket(Figure 2D)(1). The patient was subsequently extubated. DISCUSSION: Rigid bronchoscopy might be considered the preferred modality for foreign body removal, in the face of bleeding, with centrally-located foreign bodies, or massive haemoptysis. In this case, foreign bodies were distal, there was no active bleeding, and there was no other reason to proceed to the operating room, the necessity of C-spine precautions, making rigid bronchoscopy not optimal. Thus flexible bronchoscopy was deemed most suitable and could be performed at the bedside.Advancements in FB techniques have made it the initial preferred method for diagnosis and removal of foreign bodies in adults (1). FB also has advantages in its ease, less sedation requirement, less discomfort, ability to access more peripheral foreign bodies as well as being more feasible in patients with contraindications to rigid bronchoscopy(1). CONCLUSIONS: A multidisciplinary approach between cardiothoracic surgery and pulmonary medicine is recommended for successful complex removal of foreign bodies(6) with multiple adjuncts available in this highly critically ill patient. Reference #1: (1) Rafanan AL, Mehta AC. Adult airway foreign body removal: What's new? Clin Chest Med 2001;22(2):319-330. Reference #2: (2) Debeljak A, Kecelj P. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974–1998. European Respiratory Journal 2008;14(4):792-795. Reference #3: (3) Weber SM, Chesnutt MS, Barton R, Cohen JI. Extraction of dental crowns from the airway: a multidisciplinary approach. Laryngoscope 2005 Apr;115(4):687-689. DISCLOSURES: no disclosure on file for Lawrence Chin; No relevant relationships by Christine Feliu, source=Web Response no disclosure on file for Amour Patel; No relevant relationships by Barbara Robinson, source=Web Response

Bronchoscopy for Pediatric Airway Foreign Body: Thirty-Day Adverse Outcomes in the ACS NSQIP-P.

(1) Describe outcomes of bronchoscopy with foreign body removal among children on the basis of a large standardized multi-institutional data set. (2) Identify factors associated with 30-day adverse events. Cross-sectional analysis of a US national database. Public data set from the ACS NSQIP-P (American College of Surgeons National Surgical Quality Improvement Program-Pediatric) from 2012 to 2015. Children <18 years old who underwent bronchoscopy with removal of foreign body were identified. Patient demographics, comorbidities, hospitalization factors, surgical characteristics, and 30-day postoperative adverse events, including complication and readmission, were analyzed. Multivariate logistic regression identified predictive factors for postoperative complications and prolonged length of stay. A total of 275 children underwent bronchoscopic foreign body removal (n = 165 male, 60%; n = 75 nonwhite and/or Hispanic, 27%; mean age, 3.5 years [range, 0.63-17.9; median, 2.0]). Adverse events occurred among 10 children (4%). Seven had pulmonary-related complications, and 1 patient died. Three patients were readmitted; there were no reoperations. On multivariate analysis, preoperative pulmonary disease or need for pulmonary support (odds ratio [OR], 6.42; P = .04) predicted postoperative complications. Preoperative pulmonary compromise (OR, 8.10; P < .01), American Society of Anesthesiologists class 3 or 4 (OR, 4.13; P < .01), and prolonged operative time (OR, 3.05; P = .01) were associated with prolonged hospital stay. Bronchoscopy for retrieval of foreign body among children has an overall low incidence of 30-day adverse events. Children with preoperative pulmonary compromise have a significantly higher risk of postoperative complications. These findings may be applied to optimize perioperative care and counsel parents and families.

Comparison of Anesthetic Techniques on Outcomes of Pediatric Rigid Bronchoscopy for Foreign Body Removal

Background Although both methods of spontaneous respiration and controlled ventilation during anesthesia are safe and effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. This study aimed to determine the outcomes of anesthetic techniques in pediatric rigid bronchoscopy for foreign body removal. Materials and Methods In this retrospective cross sectional study, all children underwent rigid bronchoscopy for managing foreign body aspiration at Mofid hospital, Tehran, Iran from 2009 to 2015 were enrolled. Data gathering was done by a surgical technologist and using a structured checklist. The measured variables included gender, age, weight, and duration of anesthesia, duration of bronchoscopy, hospitalization in intensive care unit (ICU), and recovery time, and possible major and minor complications. Results Totally, 159 patients were assessed of whom 10 (6.5%) were maintained spontaneous respiration and 149 (99.35%) were given muscle relaxant. The mean ± standard deviation (SD) age of subjects was 27.21 ± 24.40 months, and also 61% (n=97) were male. The two groups did not differ in terms of age, gender and weight (p>0.05). Patients with controlled ventilation had a similar duration of anesthesia, duration of bronchoscopy, hospitalization in ICU, recovery time, and complications with the patients who had spontaneous respiration during bronchoscopy (p > 0.05). Conclusion Patients with spontaneous respiration and controlled ventilation during rigid bronchoscopy have a same outcome during and after the procedure. However, we strongly recommend further study in this regard.

Morbidity and mortality in children undergoing bronchoscopy for foreign body removal.

Analyze morbidity and mortality among children undergoing bronchoscopy for foreign body removal. Multicenter retrospective review using the American College of Surgeons Pediatric National Surgical Quality Improvement Program from 2014 and 2015. Patients were identified using Current Procedural Terminology code 31635. Demographics, time to surgery, operative times, hospitalization time, and complications were collected. Multivariate logistic regression was used to identify predictive factors for major adverse events. Three hundred thirty-four patients were included (mean age 3.7 years, 59.0% male). Preoperative sepsis syndrome was present in 5.7% of patients and 8.1% had asthma. Of the patients, 5.1% percent of patients had a tracheostomy. Bronchoscopy was performed by an otolaryngologist (65.4%) or a pediatric surgeon (33.1%). Mean operative time was 27.4 minutes, whereas mean total operating room time was 54.6 minutes. Airway foreign bodies were located in 269 patients (80.5%), with 62.5% being located in the mainstem bronchus. Operative time was longer when foreign bodies were in the mainstem bronchus or distal to it. Mean time to surgery from admission was 0 days, and mean duration of hospitalization was 1 day. One patient (0.3%) required reoperation for respiratory reasons, and three (0.9%) required readmission for related reasons. No patients remained hospitalized at 30 days. Two (0.6%) had a postoperative pneumonia, and two (0.6%) required reintubation. One patient death (0.3%) occurred within 2 weeks of bronchoscopy. No significant differences were identified in operative time, time to surgery, or hospitalization time based on age, gender, presence of a tracheostomy, or surgical specialty. Bronchoscopy for identification and removal of airway foreign bodies had minimal morbidity in this group. 2b. Laryngoscope, 128:1226-1229, 2018.

A Retrospective Analysis on Anesthetic Management during Rigid Bronchoscopy in Children with Foreign Body Aspiration: Propofol and Sevoflurane with Controlled Ventilation.

Background:Bronchoscopic removal of foreign body in the airway is one of the important life-saving procedure and demands skill and expertise on the part of the surgeon and anesthesiologist.Aim:To study the outcome of controlled ventilation during rigid bronchoscopy in children with foreign body aspiration.Materials and Methods:A review of fifty cases of foreign body in the bronchi, from January 2014 to December 2015 was undertaken in Vittal Institute of Child Care Hospital, Dharwad, through patient case records. Patients between 6 months and 14 years were included in the study. Cases of foreign body in the larynx and trachea were excluded. Patients were induced with propofol and maintained on sevoflurane. The parameters observed were bronchoscopy attempts, succinylcholine requirement, episodes of laryngospasm, cough, bronchospasm and spontaneous recovery. Statistical analysis was done by Chi-square test using software OpenEpi version 7.3.Results:Of 45 patients with organic foreign body, 42 (94%) patients required one attempt of bronchoscopy and 3 (6%) patients required two attempts. Five (100%) patients with inorganic foreign body required single attempt (P = 0.66). Forty-three (96%) patients with organic foreign body required two repeat doses of succinylcholine and 2 (4%) patients required three repeat doses. All 5 (100%) patients with inorganic foreign body required two repeat doses (P = 0.7461). Two (4%) patients aspirated with organic foreign body had laryngospasm, and there was no cough or bronchospasm with either patient. Two (4%) patients with organic foreign body required tracheostomy. Inorganic foreign body group of patients had lesser complications.Conclusion:In our study, patients on controlled ventilation had few intraoperative complication and smooth early recovery. Controlled ventilation with relaxation should be preferred for any pediatric bronchoscopies. Eliciting history of type of foreign body helps in planning and management of procedure.

Late onset Pneumothorax following bronchoscopic foreign body removal

Late onset Pneumothorax following bronchoscopic foreign body removal