GKD Anest Yoð Bak Dern Derg. 2021; 27(1): 59-65 | DOI: 10.5222/GKDAD.2021.31032

Our Anesthesia Experiences in the Tracheobronchial Foreign Body Aspirations of Pediatric Patients During Rigid Bronchoscopy

Yiðit Þahin¹, Tülay Çardaközü¹, Hüseyin Fatih Sezer^2
1Kocaeli University Medical Faculty, Anesthesiology and Reanimation Department, Kocaeli
²Kocaeli University Medical Faculty,Thoracic Surgery Department, Kocaeli

Objective: Bronchoscopy is the gold standard in the diagnosis and treatment of tracheobronchial foreign body aspiration (TBFBA) in children. Rigid bronchoscopy (RB) under general anesthesia is generally preferred in children. In this article, our anesthesia experiences during rigid bronchoscopy performed for tracheobronchial foreign body aspiration and removal of foreign bodies in children are shared.
Methods: The medical records of all patients aged between 0-18 years who underwent RB under general anesthesia due to suspicion of TBFBA between January 1, 2014 and December 31, 2018 were retrospectively analyzed.
Results: TBFBA was more common in boys and organic foreign body aspiration was significantly higher in patients between 13-36 months of age. Patients most frequently presented with cough and wheezing. Most of them were operated between 8 am and 4 pm. TFBs were localized in the right and left main bronchi at a similar rate. Anesthesia induction was usually achieved with iv. propofol, total intravenous anesthesia and sevoflurane inhalation was administered for maintenance of anesthesia. Except for proximally located TBFBs, intermediate-or short-acting muscle relaxants were applied to most of the cases depending on the duration of the procedure. Three patients were intubated postoperatively and transferred to intensive care unit. Respiratory distress responded to medical treatment in 25 patients. No cardiac arrest or death occurred during the procedure.
Conclusion: RB and anesthesia procedure for TBYCA requires experience. There is no clear recommendation about premedication, the use of muscle relaxants should be evaluated according to the localization of TBYC. In anesthesia management, intravenous or inhalation anesthetics can be used.

Keywords: Tracheobronchial foreign body aspiration, pediatrics, rigid bronchoscopy, general anesthesia

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Çocuk Hastalarýn Trakeobronþiyal Yabancý Cisim Aspirasyonlarýnda Rijit Bronkoskopi Süresince Anestezi Uygulamalarýmýz

Yiðit Þahin¹, Tülay Çardaközü¹, Hüseyin Fatih Sezer^2
1Kocaeli Üniversitesi Týp Fakültesi Anesteziyoloji Ve Reanimasyon Ana Bilim Dalý, Kocaeli
²Kocaeli Üniversitesi Týp Fakültesi Göðüs Cerrahisi Ana Bilim Dalý, Kocaeli

Amaç: Çocuklarda trakeobronþiyal yabancý cisim aspirasyonlarýnýn taný ve tedavisinde bronkoskopi altýn standarttýr. Çocuklarda genellikle genel anestezi altýnda rijit bronkoskopi (RB) tercih edilir. Bu makalede, çocuklarda trakeobronþiyal yabancý cisim aspirasyonlarý ve çýkarýlmasý için uygulanan rijit bronkoskopi esnasýndaki anestezi deneyimlerimiz paylaþýlmýþtýr.
Yöntem: 1 Ocak 2014-31 Aralýk 2018 yýllarý arasýnda göðüs cerrahisi anabilim dalý tarafýndan trakeobronþiyal yabancý cisim aspirasyonu (TBYCA) þüphesiyle genel anestezi altýnda RB yapýlan 0-18 yaþ arasý tüm hastalarýn dosyalarý retrospektif olarak incelendi.
Bulgular: TBYCA erkek çocuklarda daha fazla oranda görüldü, 13-36 ay arasýndaki hastalarda organik yabancý cisim aspirasyonu anlamlý dercede fazla idi, Hastalar en sýk öksürük ve hýrlýtýlý solunum þikayeti ile baþvurdular ve çoðu 08: 00-16: 00 saatleri arasýnda ameliyata alýndýlar. TBYC’ler sað ve sol ana bronþta benzer oranda lokalize idiler. Anestezi indüksiyonu genellikle iv. prpopofolle saðlandý, idamede total intravenöanestezi ve sevofluran inhalasyonu uygulandý. Proksimal yerleþimli TBYC’ler dýþýnda olgularýn çoðuna iþlemin süresiyle alakalý olarak orta veya kýsa etkili kas gevþetici yapýldý. Postoperatif 3 hasta entübe edilerek yoðun bakýma alýndý, 25 hastada solunum sýkýntýsý medikal tedaviye yanýt verdi. Ýþlem süresince arrest veya exitus olan hasta olmadý.
Sonuç: TBYCA için RB ve anestezi iþlemi deneyim gerektirir, premedikasyonla ilgili net bir öneri yoktur, kas gevþetici kullanýmý TBYC’nin lokalizasyonuna göre deðerlendirilmelidir. Anestezi yönetiminde intravenöz veya inhalasyon anestezikleri kullanýlabilir.

Anahtar Kelimeler: Trakeobronþiyal yabancý cisim aspirasyonu, çocuklar, rijit bronkoskopi, genel anestezi

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