Perioperative complications in children undergoing airway foreign body removal by rigid bronchoscopy under general anaesthesia – an observational study.

Foreign Body (FB) aspiration refers to the accidental entry of foreign body into the airway either through mouth or nose. It can occur at any age but is mostly seen in children less than 3 years of age. This occurs because young children tend to explore objects orally, along with their inability to chew the food adequately due to incomplete dentition, and due to incoordinated swallowing-breathing at this age.

The clinical features following FB aspiration depend on many factors including nature of the FB – whether organic or inorganic, size of the FB, and the duration of aspiration. The diagnosis of airway FB depends largely on history, clinical findings, and radiological imaging. Bronchoscopic removal of FB is recommended once the diagnosis is established. Both rigid and flexible fiberoptic bronchoscopes can be used for FB removal. Rigid bronchoscopes are preferred over flexible bronchoscopes because they provide a wide channel for insertion of instruments for the removal of FB. The rigid bronchoscopes also allow ventilation during the procedure through the side port.

Rigid bronchoscopy is performed under general anaesthesia. A deep plane of anaesthesia is required for the procedure. Even though bronchoscopy is safer now than it was earlier, it is associated with several complications, the reasons being the presence of airway and pulmonary pathology due to the FB, sharing of the airway by the surgeons and the anaesthetists, periods of apnoea during the procedure, among others. Minor complications include trauma to the teeth, oropharynx, or vocal cords, desaturation, hypotension, hypertension, bradycardia, tachycardia, need for postoperative oxygen supplementation, transient coughing/stridor/dyspnea after the procedure. Major complications include laryngeal edema, laryngospasm, bronchospasm, cardiac arrhythmias, pneumothorax, subcutaneous emphysema, tracheal perforation, need for postoperative mechanical ventilation or unplanned ICU admission, cardiorespiratory arrest and death.

The incidence of these adverse events is dependent on several patient, procedure and anaesthesia related factors. A few studies have evaluated the risk factors which are associated with these complications. However, most studies are retrospective in nature.

There are very few Indian studies which have studied the risk factors associated with complications during bronchoscopy. The aim of the present study is to determine the incidence of various perioperative complications in children undergoing airway foreign body removal by rigid bronchoscopy under general anaesthesia. We also propose to determine the risk factors for the development of perioperative complications.