LETTERS TO THE EDITOR
|Year : 2023 | Volume
| Issue : 5 | Page : 448-449
Anesthetic management in a 4-year-old child undergoing removal of a gemstone tracheobronchial foreign body
Shelly1, Rakesh Kumar1, TK Jayakumar2, Arvind Sinha2, Sandeep Kumar3
1 Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Neurosurgery, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
|Date of Submission||10-Apr-2023|
|Date of Decision||18-Jun-2023|
|Date of Acceptance||23-Jun-2023|
|Date of Web Publication||05-Sep-2023|
Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shelly, Kumar R, Jayakumar T K, Sinha A, Kumar S. Anesthetic management in a 4-year-old child undergoing removal of a gemstone tracheobronchial foreign body. J Indian Assoc Pediatr Surg 2023;28:448-9
|How to cite this URL:|
Shelly, Kumar R, Jayakumar T K, Sinha A, Kumar S. Anesthetic management in a 4-year-old child undergoing removal of a gemstone tracheobronchial foreign body. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Oct 2];28:448-9. Available from: https://www.jiaps.com/text.asp?2023/28/5/448/385152
Foreign-body (FB) aspiration is very common in young children <4 years of age. We share our experience of successfully removing gemstones with the help of a Fogarty catheter (FC). Informed consent from the parents was obtained for possible publication.
A 4-year-old male child, weighing 9 kg, with a history of gemstone aspiration that had occurred 18 h back, was scheduled for FB removal. A chest radiograph revealed hyperinflation of the right lung with a FB stuck in the right main bronchus [Figure 1]. On preoperative assessment, patient's respiratory rate was 30 breaths/min, oxygen saturation was 92%–95% on room air, and heart rate was 120 beats/min. The child was shifted to the emergency OT and all American Society of Anesthesiologists standard monitors were attached. After preoxygenation with 100% oxygen for 3-min child was induced with an injection of fentanyl 1 μg/kg, propofol 2–3 mg/kg, and atracurium 0.5 mg/kg, after attaining an adequate depth of anesthesia, a 5.0-mm rigid bronchoscope (Karl Storz GmbH and Co. KG, Tuttlingen, Germany) was advanced through the laryngeal opening and FB was identified that was lodged in the right main bronchus. Killian bean jaws forceps were used for the removal of the FB but due to the smooth and slippery surface of the FB, it got slipped. A multiple attempts of FB removal were made by the same technique, but every time, it got slipped. Multiple episodes of desaturation occurred during the procedure and were managed successfully by attaching the pediatric circuit to the rigid bronchoscope and ventilating the child side by side. Then, we pass a size 3 FC (Edwards Lifesciences Corporation of Puerto Rico, Irvine, CA, USA) through the main port of the bronchoscope and advance it into the right main bronchus beyond the FB, and inflated it with 0.6 mL of normal saline [Figure 2]a. Now, the FB was held with forceps, sandwiched between forceps and an inflated balloon, and the assembly was withdrawn [Figure 2]b. However, the FB slipped at the glottis level. Then, the FB was held, apposed, between the FC balloon and the forceps and brought into the trachea. A tracheotomy was performed, and the FB was removed through the incision. A 4.5 mm tracheostomy tube was placed, and the procedure was concluded. The whole procedure took around 4–4.5 h. The 2nd-day child was decannulated and discharged.
|Figure 2: (a) Gemstone foreign body (FB) with Fogarty catheter (FC). (b) Schematic diagram of sandwiching FB between rigid bronchoscope and FC|
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Smooth spherical objects are difficult to extract because they are difficult to grasp within the forceps' jaws and tend to slip, relocating distally. Moreover, the tracheobronchial tree may be traumatized by repetitive instrumentation.
Nandan et al. described FC as a reliable, repeatable method for removing airway “FB with a hole,” while Lim et al. used FC flexible grasping forceps and a modified connector for bronchial FB removal in small children. To the best of our knowledge, this is the first case where a rigid bronchoscope and FC were used for removing airway “FB without a hole.”
We conclude that FC offers a safe and effective method of managing smooth-surfaced foreign bodies; this should be viewed as an “integral” part of the bronchoscopy setup.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: A literature review of 12,979 cases. Anesth Analg 2010;111:1016-25.
Elsharkawy H, Abd-Elsayed AA, Karroum R. Management challenges in the passing-through technique using a fogarty catheter to remove an endobronchial foreign body from an infant. Ochsner J 2015;15:110-3.
Nandan R, Bajpai M, Yadav DK, Goel P. Fogarty catheter: An indispensable tool to complement the ingenuity of the endoscopist for extraction of airway “foreign body with a hole”. J Indian Assoc Pediatr Surg 2022;27:32-7. [Full text]
Lim SH, Lee DK, Lee JY. Bronchial foreign body removal under general anesthesia with a modified port, a Fogarty balloon catheter and a grasping forceps. Korean J Anesthesiol 2011;61:177-9.
[Figure 1], [Figure 2]