Annigeri Rashmi Venkatesh, Patil Rashmi Suresh
Senior Resident, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India.
Anesth Essays Res. 2017 Oct-Dec;11(4):871-874. doi: 10.4103/aer.AER_154_17.
Bronchoscopic removal of foreign body in the airway is one of the important life-saving procedure and demands skill and expertise on the part of the surgeon and anesthesiologist.
To study the outcome of controlled ventilation during rigid bronchoscopy in children with foreign body aspiration.
A review of fifty cases of foreign body in the bronchi, from January 2014 to December 2015 was undertaken in Vittal Institute of Child Care Hospital, Dharwad, through patient case records. Patients between 6 months and 14 years were included in the study. Cases of foreign body in the larynx and trachea were excluded. Patients were induced with propofol and maintained on sevoflurane. The parameters observed were bronchoscopy attempts, succinylcholine requirement, episodes of laryngospasm, cough, bronchospasm and spontaneous recovery. Statistical analysis was done by Chi-square test using software OpenEpi version 7.3.
Of 45 patients with organic foreign body, 42 (94%) patients required one attempt of bronchoscopy and 3 (6%) patients required two attempts. Five (100%) patients with inorganic foreign body required single attempt ( = 0.66). Forty-three (96%) patients with organic foreign body required two repeat doses of succinylcholine and 2 (4%) patients required three repeat doses. All 5 (100%) patients with inorganic foreign body required two repeat doses ( = 0.7461). Two (4%) patients aspirated with organic foreign body had laryngospasm, and there was no cough or bronchospasm with either patient. Two (4%) patients with organic foreign body required tracheostomy. Inorganic foreign body group of patients had lesser complications.
In our study, patients on controlled ventilation had few intraoperative complication and smooth early recovery. Controlled ventilation with relaxation should be preferred for any pediatric bronchoscopies. Eliciting history of type of foreign body helps in planning and management of procedure.
支气管镜下气道异物取出术是一项重要的挽救生命的操作，对外科医生和麻醉医生的技术和专业知识要求很高。
研究异物吸入患儿在硬支气管镜检查期间控制通气的效果。
通过患者病历回顾了2014年1月至2015年12月在达沃德维塔尔儿童护理医院的50例支气管异物病例。研究纳入6个月至14岁的患者。排除喉和气管异物病例。患者用丙泊酚诱导，七氟醚维持麻醉。观察的参数包括支气管镜检查尝试次数、琥珀胆碱需求量、喉痉挛发作次数、咳嗽、支气管痉挛和自主恢复情况。使用OpenEpi 7.3软件通过卡方检验进行统计分析。
45例有机异物患者中，42例（94%）患者需要一次支气管镜检查尝试，3例（6%）患者需要两次尝试。5例（100%）无机异物患者需要单次尝试（P = 0.66）。43例（96%）有机异物患者需要两次重复剂量的琥珀胆碱，2例（4%）患者需要三次重复剂量。所有5例（100%）无机异物患者需要两次重复剂量（P = 0.7461）。2例（4%）有机异物吸入患者发生喉痉挛，且两名患者均未出现咳嗽或支气管痉挛。2例（4%）有机异物患者需要气管切开术。无机异物组患者的并发症较少。
在我们的研究中，接受控制通气的患者术中并发症较少，早期恢复顺利。对于任何小儿支气管镜检查，应首选使用肌肉松弛剂的控制通气。了解异物类型的病史有助于手术的规划和管理。
