Anesthesia for removal of inhaled foreign bodies
in children

A M I T S O O D A N

M D

, D I L I P P A W A R

M D

A ND RA JE SHW A R I

S U B R A M A N I U M

M D

Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India

Summary

Background: Foreign body aspiration may be a life-threatening emer-
gency in children requiring immediate bronchoscopy under general
anesthesia. Both controlled and spontaneous ventilation techniques
have been used during anesthesia for bronchoscopic foreign body
removal. There is no prospective study in the literature comparing
these two techniques. This prospective randomized clinical trial was
undertaken to compare spontaneous and controlled ventilation during
anesthesia for removal of inhaled foreign bodies in children.
Methods: Thirty-six children posted for rigid bronchoscopy for
removal of airway foreign bodies over a period of 2 years and
2 months in our institution were studied. After induction with sleep
dose of thiopentone or halothane, they were randomly allocated to one
of the two groups. In group I, 17 children were ventilated after
obtaining paralysis with suxamethonium. In group II, 19 children
were breathing halothane spontaneously in 100% oxygen.
Results: All the patients in the spontaneous ventilation group had to
be converted to assisted ventilation because of either desaturation or
inadequate depth of anesthesia. There was a significantly higher
incidence of coughing and bucking in the spontaneous ventilation
group compared with the controlled ventilation group (P ¼ 0.0012).
Conclusion: Use of controlled ventilation with muscle relaxants and
inhalation anesthesia provides an even and adequate depth of
anesthesia for rigid bronchoscopy.

Keywords: anesthesia; anesthetic technique: bronchoscopy; ventila-
tion; foreign body aspiration

Introduction

The aspiration of a foreign body in a child is a life
threatening accident. Early diagnosis and broncho-
scopic removal of the foreign body would protect
the child from serious morbidity and even mortality.
In infants and children, removal of airway foreign

body is performed under general anesthesia and
through a ventilating rigid bronchoscope. Anesthe-
sia for rigid bronchoscopy is a challenging proce-
dure for the anesthesiologist who must share the
airway with the bronchoscopist and maintain ade-
quate depth of anesthesia. It is often difficult to
maintain adequate ventilation and oxygenation in
these patients. During removal of foreign body in
children, Fearson et al. (1), Chatterji et al. (2), Baraka
(3), Kim et al. (4), Perrin et al. (5), and Ahmed (6)

Correspondence to: Dilip Pawar, Department of Anaesthesia, All
India Institute of Medical Sciences, New Delhi 110029, India
(email: dkpawar@hotmail.com).

Pediatric Anesthesia 2004

: 947–952

doi:10.1111/j.1460-9592.2004.01309.x

Ó 2004 Blackwell Publishing Ltd

947