Anesthetic management for removal of tracheobronchial foreign bodies in children

Abstract

Foreign bodies aspiration are usually found in children younger than 3 years. Most of them aspirated organic materials; for example: nuts, seeds etc. Children may present with life threatening condition such as cyanosis and dyspnea, or chronic coughing, pneumonia in late presentation. Either rigid or flexible bronchoscopy is performed for diagnose and treatment in emergency or elective situation, depending on site of foreign body. Foreign body in upper part of tracheobroncheal tree especially subglottic is prone to obstruct the airway and must be removed immediately, while the lower part which is the more common site can be done as elective case. Therefore, fasting should be performed for all elective cases. Anesthesia for removing of foreign bodies in children is challenging because sharing of the small airway passage during the procedure. Anesthesiologists and otolaryngologists should be experienced and have properly discussed about intraoperative plan and emergency guideline for unexpected situations during the bronchoscopy. Whether general anesthesia with spontaneous ventilation or controlled ventilation should be used is still controversial; however: anesthetic techniques count on experience of anesthesiologists, patients’ condition and risk-benefit of those techniques.