Rapid and safe removal of foreign bodies in the upper esophagus in children using an optimized Miller size 3 video laryngoscope blade

Abstract

Background Foreign bodies lodged in the upper esophagus in children may result in life‐threatening complications, especially with button batteries. Rapid removal is essential to prevent complications. Experts report that extraction with a suitable laryngoscope and a forceps is feasible under general anesthesia, but no further data had been available so far. Aims To study foreign body visualization and removal from the upper esophagus in children using a new optimized Miller size 3 blade video laryngoscope. Methods This prospective observational study was performed in three pediatric hospitals. The clinical observations were reported anonymously on an electronic spreadsheet after obtaining the informed consent from the parents or guardians. During the observational period from January 2019 to October 2020, all children with a foreign body lodged into the upper esophagus were eligible for participation and 22 cases were included. Main outcome measures were rates of successful removal and complications as well as duration of the procedure. Secondary outcome was subjective assessment regarding the quality of the visualization and the feasibility of the procedure. Results Success rate was 100% with no complications. Mean intervention and anesthesia times were 5 ± 4 minutes and 26 ± 25 minutes. Quality of visualization of the foreign body was judged as ‘excellent’ or ‘good’ in all cases and the feasibility of the procedure as ‘without’ or ‘with little’ effort in 95% of all cases. Conclusion The new Miller size 3 video laryngoscope enables rapid, easy, and reliable extraction of foreign bodies when they are located in the upper part of the esophagus. As early removal of esophageal foreign bodies, especially with button batteries, prevents life‐threatening complications, we suggest this technique as the first choice of treatment.

Video Laryngoscope Assistance in Button Battery Retrieval

“…If not visible on intubation, then video laryngoscopy should be considered as an adjunct in any situation where there is difficulty removing a foreign body from the proximal esophagus as we described above. Given the potential catastrophic nature of button battery ingestion, we echo Kaufman et al in suggesting that any institution with a pediatric anesthetist and the resources to intubate children should attempt to expediently remove the battery prior to attempts to transfer the patient to a more specialized institution [ 10 ].…”

“…When examining the literature, case reports and observational studies of similar clinical scenarios were found in which laryngoscopy (direct or video) was a key component for foreign body removal in conjunction with a variety of instruments such as Magill forceps, hemostats, or alligator forceps [5][6][7][8][9][10]. Specifcally, Kaufman et al demonstrated that a Miller 3 video laryngoscope was successful in recovering foreign bodies from the proximal esophagus in all 22 patients in their observational study.…”

Role of the Video Laryngoscope in Removal of an Intraoperative Iatrogenic Esophageal Foreign Object

“…However, removal of foreign bodies from the esophagus with Magill forceps should be performed by experienced personnel because it may result in perforation (Bori Bata et al, 2021). Wide-angle view and good illumination of video laryngoscopes, providing better visualization and instrumentation compared with direct laryngoscopy, are advantageous in removing foreign bodies in the upper esophagus (Kaufmann et al, 2021). However, esophageal foreign bodies may not always be visualized with a videolaryngoscope.…”

Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic

“…Published data suggest that VL might shorten duration of these surgical procedures, while minimizing adverse events occurence. Furthermore, VL has been successfully used to remove foreign bodies from hypopharynx, larynx and upper esophagus, both in adult and pediatric patients [33][34][35].…”