Airway Foreign Body (FB)
Considerations
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Emergency, full stomach/aspiration risk
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Pediatric patient considerations
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Potential for airway obstruction & respiratory complications:
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Ball-valve effect & barotrauma
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Bronchospasm, laryngospasm
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Edema
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Post obstructive pneumonia/sepsis
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Rigid or flexible bronchoscopy, esophagoscopy:
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Shared airway
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Immobility required
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Ventilatory strategies, spontaneously-breathing method preferred
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Goals
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Maintain spontaneous ventilation (avoid hyperinflation/barotrauma, FB dislodgement/airway obstruction)
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Provide adequate analgesia for rigid bronchoscopy (avoid coughing/airway trauma)
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Effective teamwork with ENT throughout
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Prevent airway complications
Conflicts
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Uncooperative patient vs. spontaneous ventilation
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Deep anesthesia vs. spontaneous ventilation
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Shared airway vs. ventilation/oxygenation/deep anesthesia
Optimization
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Establish IV
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ENT STAT, call for OR & second anesthesiologist or anesthesia assistant
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Hold child in position of comfort if upper airway FB or with affected lung down if lower airway FB
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Bronchodilators
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Humidified O2, heliox
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Aspiration prophylaxis (can delay case for 8 hrs if child stable)
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Dexamethasone to reduce swelling
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Glycopyrrolate to dry secretions
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Spontaneously breathing induction methods:
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Total IV anesthesia:
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Titrate to RR 12-16 or 50% of baseline before stimulation of the child
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Inhalational with sevoflurane
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Once anesthesized, perform staged stimulation/laryngoscopy & topicalization with lidocaine
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Staged approach example steps:
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Jaw thrust
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Insert oral airway
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Do direct laryngoscpy & spray with lidocaine
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Complications
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Bronchospasm
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Laryngospasm on awakening
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Inadequate ventilation
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Pneumothorax, BPF (ball valve)
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Unable to ventilate, hypoxemia
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Complete airway obstruction:
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Push FB into a mainstem bronchus
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Hypertension, tachycardia, tachyarrhythmias
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Pulmonary hemorrage
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Post obstructive pneumonia