Paediatrics – inhaled foreign body

 

Issues:

Urgency

·         Imminent swelling (fresh peanut)

·         Imminent occlusion (spheroid)

Risks

·         Swelling

·         Occlusion

·         Pneumonia

Complex airway

·         Obstructed

·         Swollen

·         Hyperreactive

·         Shared

Drug delivery

·         No IV access

·         Open airway during fishing

Distress

·         Child: fear + separation anxiety

·         Parent: fear + guilt

 

Preparation:

Monitoring

·         Standard

Assistance

·         ENT surgeon (scrubbed + rigid bronchoscope ready)

·         Anaesthesia nurse (for airway)

·         Second anaesthetist (for IV)

·         Parent

·         Person to escort parent out

Drugs

·         IV giving set: burette + anti-reflux valves + multi-site adaptor

·         IV fluid: 20mL/kg total

·         Propofol Paedfusor Cet ready

·         Remi mcg/kg/min ready

·         IM sux ready

Equipment

·         Mask

·         Guedel

·         Laryngoscope

·         Sucker

·         MacGill’s forceps

·         MAD spray (e.g. MADgic) + lignocaine

·         ETT

·         Rigid bronch (surgeon’s)

·         HFNP if older and co-operative child

 

Anaesthesia:

Goals

·         Maintain spont vent (avoid ball-valve)

·         Maintain immobility

Pre-med

·         Midazolam 0.5mg/kg if safe

·         Topical amethocaine

Induction

·         ENT surgeon scrubbed and ready

·         Parent in the room until LOC

·         Inhalational: 70% N2O + sevoflurane

·         Topicalise above and below glottis: MADgic lignocaine 2% 3mg/kg

Maintenance

·         Propofol TCI 3-6mcg/mL

·         Remi 0.05-1 mcg/kg/min

Fishing

·         Retract ETT until tip in nasopharynx

·         Commence rigid bronch

·         Monitor rise + fall of chest

 

Feedback welcome at ketaminenightmares@gmail.com