Perioperative management of severe life-threatening airway obstruction caused  by an accidentally inhaled foreign body in an 11-month-old child: A case report

Junming Gong, Department of anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China; Department of Operating Room, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China

Li Qiu, Department of pediatrics , West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China

Fumin Zhao, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China

Xiaoqin Jiang, Department of anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China

Abstract
An 11-month-old child experienced a severe life-threatening airway obstruction due to an accidentally inhaled foreign body that had become lodged in his tracheal carina. He showed shortness of breath, continued to groan, and had three positive concave signs when he came to our emergent department. The blood gas analysis showed the following: pH 7.14, partial pressure of CO2 (PCO2) 79.4 mmHg. Then intubation (13 cm depth) with a 4.0-mm tracheal catheter was performed, followed by invasive mechanical ventilation. Chest computed tomography (CT) was also performed. However, 2 hours after invasive mechanical ventilation, PCO2 dramatic increased from 79.4 to 157mmHg. Emergency FAB removal using flexible bronchoscope was performed under general anesthesia to avoid sudden death because of severe asphyxiation. foreign body was found to lodge in his tracheal carina, and the cavity was nearly blocked. The AFB was removed on the first attempt without complications. The child recovered uneventfully and was discharged 2 days later. As result, we would urge caution that If an AFB is suspected, and PCO2 dramatic increased after invasive mechanical ventilation, emergency FAB removal should be performed immediately to avoid sudden death due to severe asphyxia. A standard pediatric flexible bronchoscope (2.8 mm outer diameter) can be inserted successfully via a size 4.0 endotracheal tube for AFB removal.

Keywords
airway foreign body removal, flexible bronchoscope, Intraoperative anesthetic management

Cite this paper
Junming Gong, Li Qiu, Fumin Zhao, Xiaoqin Jiang, Perioperative management of severe life-threatening airway obstruction caused by an accidentally inhaled foreign body in an 11-month-old child: A case report , SCIREA Journal of Clinical Medicine. Volume 6, Issue 2, April 2021 | PP. 115-124. 10.54647/cm32436

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