Purpose: Tracheobronchial foreign body (TFB) aspiration is a life-threatening emergency for children. Knowing how to reduce the incidence of complications and mortality during the management of TFB is critically important.
Methods and patients: Pediatric patients with TFB, who were treated in the Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong Province, China, were included in this analysis during 1985 to 2007. One thousand four hundred twenty-eight patient records with TFB were retrospectively reviewed. This study mainly reported location and type of foreign body, complications, anesthesia methods, and outcome.
Results: Among the 1428 patients, 1424 (99.72%) underwent successful removal of a foreign body by bronchoscopy. First-attempt removal was successful in 1347 whose bronchoscopy was done under general anesthesia combined with topical anesthesia and in 65 cases with inhaled anesthesia by ether combined with topical anesthesia, respectively. Second-attempt removal was successful in 12 patients whose bronchoscopy was done under inhaled anesthesia by ether combined with topical anesthesia. Foreign bodies were located in the trachea in 75 cases (5.25%), right bronchial tree in 780 patients (54.62%), left bronchial tree in 567 cases (39.71%), and bilateral bronchial tree in 6 cases (0.42%). Types of foreign body included peanuts (1244 cases, 87.12%), beans (93 cases, 6.51%), and others (91 cases, 6.37%). Tracheotomy was performed in 4 patients. Three patients (0.21%) died in this study. Four patients developed toxicity from tetracaine during topical anesthesia.
Conclusions: Bronchoscopy under general anesthesia augmented with topical anesthesia is a very safe and effective procedure for patient with TFB. Surgeons and anesthetists must be aware of the risk of tetracaine toxicity and other complications.