Anesthetic management of tracheobronchial foreign body removal

Introduction: Tracheobronchial foreign body removal, is a common emergent problem especially in pediatric population and it is associated with greatest challenge to the anesthesiologist as well as to the surgeon as the airway has to be shared by both. Various pulmonary changes associated with foreign body impaction also occurs. Methods: This is a retrospective analysis of foreign body removal of tracheobronchial tree in Institute of Medicine, Tribhuvan University Teaching Hospital over the last three years (April 2006 – April 2009). Data regarding age, sex, presentation/signs, anesthetic technique, site and types of foreign body, intraoperative events and postoperative outcomes were collected. Results: The age range of the patients was from 6 months to 18 years. Total cases were 49. Most of the foreign bodies were organic (60%) and the common site was in right bronchus (64%). The cases were managed either with assisted ventilation or controlled ventilation intraoperatively. Most of the cases presented with dyspnoea. Postoperatively few cases (5 cases) needed to be ventilated electively in intensive care unit, while most of the cases needed oxygen supplement for few hours postoperatively. Conclusions: Anesthetic management of tracheobronchial foreign body is challenging for both the anesthesiologist and the surgeon. The only way for the better outcome, is excellent communication in both parts i.e. anesthesiologists and surgical team, as well as timely information and involvement of other experts like paediatrician, before the procedure.