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Foreign body
aspiration.
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FOREIGN BODY ASPIRATION
Bronchi 80-90%
Right mainstem most common
Carina
Less divergent angle
Greater diameter
Trachea
Larynx
Largerobjects, irregular edges
Conforming objects
Relevant Anatomy
Airway foreign bodies can become
lodged in the larynx, trachea, and
bronchus. The size and shape of the
object determine the site of obstruction.
large, round, or expandable objects
produce complete obstruction, and
irregularly shaped objects allow air
passage around the object, resulting in
partial obstruction.
TYPES OF OBSTRUCTION.
1. check valve: air can be inhaled but
not exhaled.[emphysema].
2. ball valve: air can be exhaled but not
inhaled.[broncho pul segment collapse].
3. bypass valve: FB partially obstructs
both in insp. and exp.
4. stop valve: total obstruction, airway
collapse and consolidation.
Presentation
In general, aspiration of foreign bodies
produces the following 3 phases:
Initial phase - Choking and gasping,
coughing, or airway obstruction at the time
of aspiration
Asymptomatic phase - Subsequent lodging
of the object with relaxation of reflexes that
often results in a reduction or cessation of
symptoms, lasting hours to weeks
Complications phase - Foreign body
producing erosion or obstruction leading to
pneumonia, atelectasis, or abscess
Foreign Body Aspiration
History
Choking
Gagging
Wheezing
Hoarseness
Dysphonia
Obstructive emphysema
Normal x-ray
Pneumonitis
Collapse with mediastinal shift
Foreign body.
If still a diagnostic delima,CT scan is
advised.
Foreign Body Aspiration
Foreign Body Aspiration
Foreign Body Aspiration
Foreign Body Aspiration
Indications
Perform surgical intervention with rigid
bronchoscopy on patients:
who have a witnessed foreign body aspiration.
those with radiographic evidence of an airway
foreign body.
those with the previously described classic
signs and symptoms of foreign body aspiration.
A strong history of suspected foreign body
aspiration prompts an endoscopic evaluation,
even if the clinical findings are not as
conclusive or are not present
Contraindications
No contraindications exist to the removal
of an airway foreign body from a child.
If necessary, health problems can be
optimized before surgical intervention.
However, even children who are at high
risk due to health reasons still need
surgical intervention to remove the
foreign body.
History of the Procedure
Until the late 1800s, airway foreign body
removal was performed by bronchotomy.
The first endoscopic removal of a foreign body
occurred in 1897.
Chevalier Jackson revolutionized endoscopic
foreign body removal in the early 1900s with
principles and techniques still followed today.
The development of the rod-lens telescope in
the 1970s and improvements in anesthetic
techniques have made foreign body removal a
much safer procedure.
Foreign Body Aspiration
Goal of treatment
Prompt endoscopic removal under
conditions of maximal safety and
minimal trauma.
GA is always technique of choice.
Communication and cooperation
between anaesthetist and endoscopist is
must.
ANAESTHETIC MANAGEMENT
Challanging;
Fighting irritable child.
Full stomach.
Sharing of airway.
Difficult to maintain oxygenation and
ventilation,as pulmonary gas exchange
is already reduced.
Difficulty pertaining to pediateric airway.
Usually NOT A DIRE EMERGENCY
Trained personnel
Instruments assembled and checked
Await for emptying of stomach
Find duplicate FB to test instruments and
techniques
Preoperative considerations.
Severity of airway obstruction, gas
exchange and level of conciousness.
Nature and location of FB,degree and
duration of obstruction.
fasting status. Delaying intervention
must be balanced against potential
functional impairment and oxygenation.
metoclopramide 0.15mg/kg iv.
Atropine 0.02mg/kg iv.
Foreign Body Aspiration
General anesthesia
Spontaneous ventilation
Laryngoscopes
Bronchoscopes
Suction
Forceps
Rod-lens telescopes
GOALS OF ANAESTHESIA
1. Adequate oxygenation.
2. Controlled cardiorespiratory reflexes
during bronchoscopy.
3. Rapid return of airway reflexes.
4. Prevention of pulmonary aspiration.
5. Meticulous monitoring :
spo2,ECG,NIBP,EtCO2.
TECHNIQUE
Oxygen sevoflurane induction.
Monitor, IV line.
Ketamine 2mg/kg- safe in peadtric pts,full
stomach,leaves cough reflex intact,provides
CVS stability and prevents bronchospasm.
Atropine 0.02mg/kg- dec secreations and
obtund autonomic reflexes during airway
instrumentation.
Nitrous oxide is avoided,as it inc gas volume,air
traping and possible rupture of affected lung.
Suxa 1.5 mg/kg if controlled ventilation planned.
Foreign Body Aspiration
Bronchoscopy
Suction opposite bronchus
IPPV through side arm mapelson F circuit.
Advance to foreign body
Atraumatically grasp foreign body
Repeat bronchoscopy
Suction bronchus
Complications
Larago/bronchospasm; ms.
Relaxation,adequate ventilation.
Arrhythmias: hyperventilation , lignocaine.
Pneumothorax
Pneumomediastinum
Pneumonia
Antibiotics, physiotherapy
Atelectasis
Expectant management, physiotherapy
If postop stridor or distress: nebulise with
racemic Epinephrine.
Observe the child in recovery room for
signs of subglotic odema, haemorhage,
bronchospasm and airway perforation.
Postop SPO2 and ECG monitoring.
6-8hrs later chest x-ray to assess-lung
expantion, exclude pneumothorax,
residual FB,mediastinal emphysema
from barotrauma.
THANK YOU.
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