ANAESTHETIC MANAGEMENT OF TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION IN CHILDREN: AN ANALYSIS OF 55 CASES AT A TERTIARY CARE HOSPITAL - BANGALORE

Kavya R Upadhya, Chandrika Y Ramavakoda

Abstract


Aspiration of foreign body is a common problem in children around the world. Asphyxiation due to foreign body is a leading cause of death among
children younger than 4 years of age.
AIM: To describe our experience with management of foreign body aspiration and review published literature.
Materials and methods: An observational retrospective study was conducted for a period of one year (2016-17), in Indira Gandhi institute of child
health, Bangalore. 55 patients less than 12 years of age with foreign body aspiration were evaluated and the anaesthetic management reviewed.
Results: Out of the 55 patients assessed, 60% of the patients were below 3 years of age and 40% were above 3 years of age. Rigid bronchoscopy was
done under general anaesthesia and 44 cases were positive for foreign body. The most frequently aspirated object was groundnut with cough being
the most common symptom. In our study we found an almost equal incidence of foreign body in right (32.73%) and left bronchus (34.54%),
contrary to several other studies followed by tracheal foreign body in 12.73%. Spontaneous ventilation was carried out in 4 patients with tracheal
foreign body while controlled ventilation was carried out in the remaining cases. The most common complication was desaturation (36.36%),
followed by intubation at the end of surgery for respiratory distress (14.55%) and laryngospasm (7.27%). Bronchospasm with reversal of shunt was
seen in a case of Tetralogy of Fallot, with a tracheal foreign body and foreign body superimposed with asthma were some other challenges
encountered.
Conclusion: The difference in tracheal bifurcation angles between adults and children below ten years of age explains the equal incidence of
foreign body impaction in right and left bronchus in our study. Use of controlled ventilation with muscle relaxants provided adequate depth of
anaesthesia with minimal complications and use of spontaneous ventilation is preferred in unstable patients with proximal foreign body.


Keywords


Child, Foreign Bodies, General Anaesthesia, Retrospective Studies, Bronchoscopy

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