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Chapter 46. Management of a 12-Year-Old Child with a Foreign Body in the Bronchus

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Which of the following agents is NOT recommended for an inhalational induction for the removal a foreign body from the trachea?

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A. Desflurane

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B. Atropine

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C. Midazolam

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D. Sevoflurane

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E. Halothane

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(A) Inhalational agents, such as isoflurane, enflurane, and desflurane, are more likely to produce airway irritation on induction and are commonly avoided for the inhalational induction of anesthesia to remove a foreign body from the trachea.

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Which of the following options is the least reasonable adjunct to removal of an airway foreign body?

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A. LMA

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B. Flexible bronchoscope for object removal

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C. Avoidance of the use of nitrous oxide

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D. Avoidance of IPPV

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E. Removal of the foreign body through a rigid bronchoscope

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(B) The use of flexible bronchoscopy (FB) for foreign body removal is not widely practiced but its use is on the rise. The main downsides are that the foreign body cannot be ensheathed within the FB to protect the airway during its removal, potentially increasing the risk of injury to the airway if the object is sharp. It also increases the risk of complete airway obstruction, if the object is dropped as it is retracted proximally, the riskiest point being at the glottis.

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Surgical removal of an airway foreign body is recommended under all of the following circumstances EXCEPT

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A. If the foreign body is sharp, pointed, and embedded in the tracheal or bronchial wall.

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B. If the foreign body is found in a small inaccessible peripheral bronchus.

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C. If the foreign body has been present for a prolonged period often for several years.

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D. If there is significant instability in maintaining control of the airway upon insertion and manipulation with the bronchoscope.

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E. If the foreign body is lodged at the carina.

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(E) Open surgical procedures are seldom required to remove foreign bodies from the airway and a foreign body lodged at the carina should generally be readily retrievable through a rigid bronchoscope.

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