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[Clinical analysis of tracheobronchial foreign bodies in children in 1276 cases]
Fugao Zhu1, Meihong Sun, Fuqin He
1Department of Otolaryngology, Affiliated Hospital of Medical College, Qingdao University, Qingdao, 266003, China. zhufugao@yahoo.com.cn
Insights
Total intravenous anesthesia is the safest and most effective method for removing foreign bodies from the respiratory tract, significantly reducing complications and mortality rates compared to aspiration anesthesia.
Area of Science:
- Pulmonology
- Anesthesiology
- Medical Devices
Context:
- Foreign body aspiration is a common cause of respiratory distress, particularly in children.
- Effective management is crucial to prevent severe complications such as airway obstruction, infection, and death.
Purpose:
- To evaluate the efficacy and safety of different anesthesia methods for bronchoscopic foreign body removal.
- To identify factors influencing procedural success and complication rates.
Summary:
- A review of 1276 cases of respiratory tract foreign bodies treated with bronchoscopy.
- Total intravenous anesthesia demonstrated a higher success rate (99.9%) and fewer laryngeal edema complications compared to ether aspiration anesthesia.
- Mortality rate was 0.24%, with deaths attributed to apnea.
Impact:
- Total intravenous anesthesia, combined with surface anesthesia, is recommended as the ideal method for bronchoscopic foreign body removal.
- Highlights increased risks associated with bean foreign bodies, atelectasis, and younger patients.
- Emphasizes the potential need for tracheotomy in select cases.
Objective:
To investigate the effective therapy methods of foreign bodies in respiratory tract to lower its complications and the mortality rate.
Method:
Review the anesthesia methods, operation methods and therapeutic efficacy of 1276 cases of foreign body in respiratory tract and report three cases of death.
Result:
Under total intravenous anesthesia we took out foreign bodies by bronchoscope in 1197 cases and did that successfully for the first time in 1196 cases. Under aspiration anesthesia by ether we took out foreign bodies by bronchoscope in 78 cases and did that successfully for the first time in 65 cases, we took foreign bodies for the second time in 12 cases. We carried out tracheotomy in three cases. Edema of larynx was found in 12 cases among which 11 cases were under aspiration anesthesia by ether and one case was under total intravenous anesthesia. Under total intravenous anesthesia, the longest time of operation was 45 minutes, we could carry out the examination by bronchoscope for five times and no edema of larynx was found in all cases. Under aspiration anesthesia by ether, the longest time of operation was limited to 5 - 10 minutes, we could carry out the examination by bronchoscope for three times at most; otherwise, edema of larynx was very severe. Three cases died over apnea. Mortality rate is about 0.24%.
Conclusion:
Total intravenous anesthesia combined with surface anesthesia of respiratory tract mucosa is the ideal anesthesia method for taking out foreign bodies in respiratory tract by bronchoscope. It is more dangerous in cases that the foreign bodies are bean or that atelectasis is found. We should notice that the less the patients are, the more dangerous the operation is. In some cases tracheotomy is needed.
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