Foreign body removal with repair of iatrogenic tracheo-bronchial tear repair: An anesthetic challenge

Abstract

Foreign body aspiration into the airway is common in the pediatric age group and its anesthetic management is a challenge. Iatrogenic tracheo-bronchial injury further worsens the situation. Flexible pediatric fiberscope is the gold standard for securing the airway in cases of airway injury. We present a case of a 7-year-old girl who presented to the hospital with signs and symptoms of foreign body aspiration and suspected tracheo-bronchial tree injury. The impacted foreign body was removed by rigid bronchoscopy and the presence of a tracheo-bronchial tear was confirmed. To repair the airway tear, thoracotomy was planned necessitating one lung ventilation. A pediatric flexible fiberscope was not available, so left endobronchial intubation for one lung ventilation was done with the help of an airway exchange catheter using a rigid bronchoscope as a conduit. Subsequent intra-operative and post-operative period were uneventful.

Complications of tracheobronchial foreign bodies

“…Pointed foreign bodies may cause superficial or deeper injuries in the airway mucosa and hemoptysis or perforation may occur as a result of these damages. However, airway injuries are usually seen related to bronchoscopy procedures (34). In our series, pneumomediastinum was seen in 2 patients (0.3%).…”

Iatrogenic tracheobronchial tear during paediatric thoracoscopic oesophageal repair: an anaesthetic challenge

“…Lahori et al encountered an iatrogenic tracheal tear during rigid-bronchoscopic retrieval of a foreign body in a 7-year-old. Due to unavailability of FOB, the rigid bronchoscope was used as a conduit for an airway exchange catheter for endobronchial intubation 8. Ho et al report a case of emergency blind left main stem bronchial intubation in a neonate with rupture of emphysematous bullae on the right side, with a similar technique of turning the head to the right, and rotation of the ETT by 180⁰, such that the Murphy’s eye of the ETT faces left instead of right.…”

Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases

“…[5] Conventional ventilatory management with endotracheal intubation and positive pressure is likely to cause air leakage and produce further deterioration of pulmonary function. Shimazu et al .…”