Anesthesia with propofol‐remifentanil combined with rocuronium for bronchial foreign body removal in children: Experience of 2 886 cases

Abstract

Importance: The appropriate anesthetic method can reduce the complications of children with tracheal foreign body and reduce the mortality rate of children. What kind of anesthetic method to choose has always been the focus of debate. Purpose: To evaluate the efficacy and safety of anesthesia with propofolremifentanil combined with rocuronium for foreign body aspiration (FBA) removal with the positive-pressure ventilation technique. Methods: Medical records of patients who underwent bronchoscopy for evaluation of FBA in our unit from January 2015 to January 2018 were retrospectively reviewed. Demographic data (age and sex), nature of foreign body and location, complications, length of hospital stay and outcome were analyzed. Results: A total of 2 886 children were included in this study. The median age was 24 months (8 months to 10 years). FBA was detected and removed in 95.6% of patients. The average operation time was 17 ± 5 min and average length of hospital stay was 2 days. Observed peri-interventional complications included desaturation (n = 66), laryngospasm (n = 19), laryngeal or subglottic edema (n = 15), irritating cough (n = 3), body movement (n = 76) and pneumonia (n = 206). No deaths occurred during hospitalization or follow-up in this series. Interpretation: Anesthesia with propofol-remifentanil combined with rocuronium under positive-pressure ventilation is an effective and safe technique during FBA removal in children.

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

“…Rocuronium, a non-depolarizing, short-acting neuromuscular blocker with a short half-life, causes minimal hemodynamic response and no histamine release. Rocuronium has been shown to significantly reduce the risk of laryngospasm and bronchospasm when used in combination with remifentanil 21. In our study, remifentanil was used in almost all the patients and the findings obtained were consistent with those reported in the literature.…”

Efficacy and Safety of Remimazolam Besylate Combined with Alfentanil in Painless Gastroscopy: A Randomized, Single‐Blind, Parallel Controlled Study

“…In clinics, sedative hypnotics and opioid narcotic analgesics are often used in anesthesia induction and maintenance [ 15 ]. When two or more drugs are used simultaneously or successively, the drug interaction may occur by modulating the drug action site, competitively binding with the receptor, or affecting the receptor's sensitivity to another drug, that is, synergistic, additive, or antagonistic action [ 16 ]. Moreover, synergism and additivity are what we expect, and antagonism is what we want to avoid.…”

Management of Foreign Body Aspiration in Children: Insights From 664 Cases in the Operating Room

“…Some studies have stated that spontaneous breathing and propofol-remifentanil anesthesia might delay cough, apnea, body movement, and awakening during the removal of the foreign body. 4 We used the short-acting rocuronium as a muscle relaxant to reduce the complications arising from manipulations during the removal of the foreign body with the combination of propofol-fentanyl or remifentanil.…”

“…Oxygenation and ventilation problems may occur due to joint use of the airway with the anesthesiologist and the clinician performing bronchoscopy. 4,5 Different ventilation methods (controlled and spontaneous ventilation) can be applied according to the experience of the anesthesiologists and hospital protocols. 6 The disadvantage of spontaneous ventilation is that the foreign body can be displaced by airway reflexes (cough, laryngospasm, or bronchospasm).…”

“…7 Positive pressure ventilation reduces atelectasis and increases oxygenation. 4 Foreign body aspirations are a serious health problem that can lead to fatal outcomes in childhood. According to the literature, although most deaths occur before admission to the hospital, anesthesia management and bronchoscopy procedures are also important causes of mortality and morbidity.…”