The Journal of Medical Sciences

Register      Login

VOLUME 7 , ISSUE 3 ( July-September, 2021 ) > List of Articles


Bronchoscopic Removal of an Unusual Foreign Body Trachea

Rajashree Godbole, Abhijit P Benare, Swapnal Ugale, Aniya Shouk

Keywords : Foreign body, Glass piece, Pediatric, Rigid bronchoscopy, Trachea

DOI: 10.5005/jp-journals-10045-00208

License: CC BY-NC 4.0

Published Online: 15-12-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Introduction: Rigid bronchoscopy under general anesthesia (GA) is the gold standard for pediatric foreign body (FB) removal. Fiberoptic bronchoscopy (FOB) can be tried with rigid bronchoscopy backup. Case description: A 3-year-old child has a cough with hemoptysis. Chest X-ray—an opaque shadow in the trachea. Discussion: Induction with inhalation anesthetic or intravenous (IV) drugs and controlled ventilation is suitable for rigid bronchoscopy. Quiet patient during induction avoids displacement of FB, no sedative premedication to maintain respiration. Steroids—dexamethasone 0.4–1 mg/kg for treatment of inflammation and airway edema. Antibiotic for pulmonary infection and jet ventilation during bronchoscopy can avoid hypoxia and atelectasis but increases the chances of barotrauma; neuromuscular blockade suppresses the patient’s mobility and reflexes to avoid airway trauma and coughing to make the surgeon comfortable. Securing IV line before induction of anesthesia and analgesia for postoperative pain relief. IV anesthesia technique with propofol, fentanyl/remifentanil is becoming popular for maintenance of a constant level of anesthesia during bronchoscopy. Conclusion: For pediatric glass FB bronchus/trachea removal, rigid bronchoscopy under GA is the safest choice. Ventilating bronchoscope with side arm ventilation and muscle relaxation is the recommended method for airway glass FB removal to avoid damage to the airway, vocal cords, and oral structures.

  1. Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12979 cases. Anesth Analg 2010;11(4):1016–1025. DOI: 10.1213/ANE.0b03e3181ef3e9c
  2. Salih AM, Alfaki M, Alam-Elhuda DM. Airway foreign bodies: a critical review for a common pediatric emergency. World J Emerg Med 2016;7(1):5–12. DOI: 10.5847/wjem.j.1920-8642.2016.01.001
  3. Kendigelen P. The anaesthetic consideration of tracheobronchial foreign body aspiration in children. J Thorac Dis 2016;8(12):3803–3807. DOI: 10.21037/jtd.2016.12.69
  4. Farrell PT. Rigid bronchoscopy for foreign body removal: anaesthesia and ventilation. Paediatr Anaesth 2004;14(1):84–89. DOI: 10.1046/j.1460-9592.2003.01194.x
  5. Dikensoy O, Usalan C, Filiz A. Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J 2002;78(921):399–403. DOI: 10.1136/pmj.78.921.399
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.