Anaesthesia for Foreign Body Removal from Airway In Children

Abstract

Foreign body in paediatric airway is a common and a potentially life threatening situation. Presenting symptoms of an inhaled foreign body depends on time since aspiration. Immediately after inhalation the child may show symptoms of airway obstruction like cough, wheeze or have laboured breathing. If the early signs are missed, the child usually presents with fever and other signs and symptoms of chest infection. The removal of foreign body presents considerable problems both to the endoscopist and the anaesthesiologist. It is challenging procedure for the anaesthesiologist to maintain airway for adequate ventilation and oxygenation in patients whose pulmonary gas exchange is already compromised. Children below 3 years of age are found to be very vulnerable for aspiration. Airway surgery demands a high level of co-operation between surgical and anaesthetic teams. The gold standard for diagnosis and management of foreign body airway is rigid bronchoscopy under general anaesthesia. For late presentations, time should be taken for fasting the child and to complete a thorough evaluation before bronchoscopy. The  procedure should be performed in a well equipped room with at least two experienced anaesthesiologists. Preferred choice of anaesthetic induction is inhalational rather than intravenous induction and using a ventilating bronchoscope rather than endotracheal intubation. However anaesthetic goals focus on adequate oxygenation and ventilation, controlled cardiorespiratory reflexes during bronchoscopy rapid return of upper airway reflexes, prevention of pulmonary aspiration and meticulous monitoring in intra operative and post operatively period.