Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker

Abstract

Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male. RB is generally the preferred approach for extraction of a large complex FB; however, due to its size, the FB had to be removed using FLXB combined with an endobronchial blocker. In this report, we describe the anesthetic and surgical considerations and the novel technique used to extract the FB.

Failures in emergency management of pediatric airway foreign bodies by rigid bronchoscopy: we have yet to complete our learning

“…After this, FFB has been widely used for airway FB extraction and is now regarded as the first line in this field, especially in challenging patients. [14][15][16] This type of bronchoscope can be used effectively in patients where FBs are impacted too distally, in patients with cervical trauma or instability, in patients with congenital oral or airway malformations, and in mechanically ventilated cases. While RB needs to be done under general anesthesia in the OR and is risky in some cases, FFB can be done under local anesthesia and intravenous sedation in the bronchoscopy suite, 17 although rare cases may still need more invasive surgical interventions, such as thoracotomy and bronchotomy.…”

“…Zavala and Rhodes13 indicated the application of FFB for removing FB in artificial lungs and animal models. After this, FFB has been widely used for airway FB extraction and is now regarded as the first line in this field, especially in challenging patients 14–16. This type of bronchoscope can be used effectively in patients where FBs are impacted too distally, in patients with cervical trauma or instability, in patients with congenital oral or airway malformations, and in mechanically ventilated cases.…”

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury

“…Aspiration of foreign body is uncommon but can possibly cause death. In emergency cases, the success rate of foreign body removal by bronchoscope can be as high as 90% if it was diagnosed accurately [6] , [7] .However 2.5% of the cases in which the foreign body more in a peripheral location need thoracotomy for their removal [4] . Most of the foreign body was found mainly at the right (33%) and left (27%) main bronchus [1] .…”

“…The most serious complication that has been reported was uncontrolled bleeding, lacerated trachea and lacerated vocal cord [1] . Apart from bronchoscopy technique removal of foreign body; the use of bronchial blocker tube has been reported to be used along the fibreoptic bronchoscope as an adjunct [7] . Undiagnosed or missed diagnosed foreign body aspirate can be detrimental as hypoxia can lead multiple organ sequelae and among them is cardiac arrest [8] .…”