E Foreign body aspiration
Aspiration of foreign bodies is a common problem. There is a high morbidity and mortality, particularly in children, who aspirate foreign objects. Some common aspirants include peanuts, popcorn, jelly beans, coins, and bites of meat and hot dogs. The majority of aspirated items are food particles; however, beads, pins, and small toys are not unusual. A common site of foreign body aspiration is the right bronchus. If the patient is supine when the aspiration occurs, the object will most likely be found in the right upper lobe. If the patient is standing, the right lower lobe is most likely to be affected. Signs of aspiration include wheezing, choking, coughing, tachycardia, aphonia, and cyanosis. These signs indicate an obstructive severe irritation and swelling in the airway. As a result of the swelling, air may be trapped in the lungs, not allowing adequate expiration.
2. Anesthetic technique
a) The anesthetic management depends on the location of the airway obstruction, the size and location of the object, and the severity of the obstruction. If it is located at the level of the larynx, a simple laryngoscopy with Magill forceps should allow for easy removal of the object.
b) Care must be taken not to dislodge the object and allow the object to fall deeper into the airway. If the foreign body is located in the distal larynx or the trachea, the patient should have an inhalation induction performed in the operating room, maintaining spontaneous respiration. With the patient spontaneously breathing, the surgeon will most likely use a rigid bronchoscope for extraction of the foreign body.
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