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Anesthesia for foreign bodies in the tracheo-bronchial tree in children
Insights
This study details anesthetic and ventilation methods for pediatric foreign body aspiration. High-frequency percussive ventilation (HFPPV) proved effective and safe in managing these cases.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Otolaryngology
Background:
- Foreign body aspiration is a significant risk in children.
- Prompt diagnosis and intervention are crucial for favorable outcomes.
Purpose of the Study:
- To evaluate anesthetic and ventilation techniques for pediatric foreign body aspiration.
- To assess the efficacy and safety of High-Frequency Percussive Ventilation (HFPPV).
Main Methods:
- Retrospective analysis of 106 children with suspected foreign body aspiration.
- Anesthesia induction with halothane; maintenance with etomidate or thiopental.
- Ventilation techniques including intermittent oxygen jet injection and HFPPV.
Main Results:
- A foreign body was found in 62 children, predominantly organic (80%), especially peanuts.
- Bronchial and right-sided foreign body locations were most common.
- HFPPV demonstrated satisfactory results with few complications.
Conclusions:
- Anesthetic and ventilation strategies, particularly HFPPV, are effective for pediatric foreign body aspiration.
- Early intervention and appropriate techniques minimize morbidity and mortality.
Abstract:
The authors present the anesthetic and ventilation techniques, used in 106 children, who were suspected of foreign body aspiration in the respiratory tract. In 62 children a foreign body was found. The youngest child was 8 months old and the oldest 13 years, with an age distribution peak in the 1 to 2 years age group. A predominance for the male sex (60%) was present. Foreign bodies of organic nature were found most frequently (80%), 39 of them consisting of peanuts. The bronchi were involved more often than the trachea and the foreign body was located more frequently at the right bronchus (38 pt). The children were ventilated initially with an intermittent oxygen jet injection technique, using a home made apparatus, but since 1978 with HFPPV, using the AGA Bronchovent. Induction of anesthesia was done with halothane and maintenance with etomidate infusion (10-20 micrograms/kg/min.) or thiopental increments (2 to 3 mg/kg). The technique so far used, proved to be satisfactory, specially since HFPPV is used. Few complications occurred. One child died during the bronchoscopic procedure and in an other child a tracheostomy had to be performed for extraction of the foreign body.