Inhaled foreign bodies in pediatric patients: review of personal experience

BACKGROUND: Foreign bodies (FBs) are a life-threatening event in children that require early diagnosis and prompt successful management. The ideal means of FB removal is rigid bronchoscopy under general anesthesia, although the choice between spontaneous or controlled breathing and the type of drug used are still subjects of discussion. We made a review of the literature and report our experience on FB inhalation, nature and location of FB, diagnostic method, prediction, perioperative complications, type of anesthesia, ventilation and total duration of the surgical procedure. METHODS: Forty-six children undergoing rigid bronchoscopy for suspect FB aspiration were retrospectively assessed. Relevant clinical and radiological findings were retrieved. During endoscopic procedures induction and maintenance of anesthesia were performed by intravenous or volatile drugs associated with topical airway lidocaine under spontaneous breathing. RESULTS: The most common symptoms were cough and dyspnea. Radiological examination was beneficial in 34 patients. At bronchoscopy, organic and inorganic FBs were located largely in bronchial tree and removed in 40 of the 46 children. All patients maintained spontaneous ventilation using volatile and intravenous anesthesia in 22 and 24 children, respectively. The mean surgical time was 79 min. Perioperative complications such as bronchospasm, bleeding and desaturation were observed in five patients. CONCLUSIONS: FB inhalation is an uncommon life-threatening event in pediatric patients that can manifest with various symptoms. Rigid bronchoscopy is the procedure of choice for diagnosis and management of FB inhalation in pediatric patients. Spontaneous ventilation can be considered safe, using either volatile or intravenous agents. Perioperative complications were not correlated with either the choice of agent (volatile or intravenous) or the duration of surgery. A close collaboration between anesthesiologists and otorhinolaryngologists and a long-standing experience in pediatric airway emergencies are the key factors for obtaining good results.