关键词: 支气管异物, 支气管镜检查, 麻醉, 儿童

Abstract: Objective To investigate feasible airway management and anesthesia protocols during rigid bronchoscopy for critical children with tracheobronchial foreign bodies. Methods We selected 134 critical children with tracheobronchial foreign bodies. After the children entered the operating room, they were supplied oxygen via a face mask or underwent endotracheal intubation. Preoperative medication was usually administered intravenously and included penehyclidine hydrochloride(0.03 mg/kg)and dexamethasone(0.4~0.5 mg/kg). Among the patients, 119 without respiratory distress syndrome were administered low doses of rocuronium together with intravenous anesthesia; 13 with respiratory distress were administered intravenous anesthesia to preserve spontaneous breathing; and two with severe respiratory distress and unconsciousness underwent rigid bronchoscopy performed by an otolaryngologist. High-frequency jet ventilation was discontinuously implemented based on the intraoperative blood oxygen level, with a ventilation frequency of 60-80 times per minute, an I/E ratio of 1∶1.5, and a drive pressure not exceeding 60 kPa. After completion of the surgery, we ensured the recovery of spontaneous respiration; no significant postoperative vomiting and respiratory depression occurred. Thereafter, the children were transferred to either the postoperative care room for otolaryngology patients or the PICU for further observation. Results The foreign bodies in each of the children were successfully removed through a single operation. No serious laryngospasm or bronchospasm, forced withdrawal of the mirror due to breath holding or coughing, or anesthesia accident occurred during the operations. Owing to prolonged hypoxia, one patient died of multiple organ failure 8 hours after the operation. The remaining patients recovered with stable postoperative vital signs and were discharged after 3-8 days of treatment. Conclusion Anesthesiologists should adopt different anesthetic protocols during rigid bronchoscopy, based on the degree of dyspnea, to ensure adequate oxygen supply, to avoid false aspiration of gastric contents, and to prevent airway spasms, and should assist otolaryngologists in relieving airway obstruction as soon as possible.

Key words: Bronchi foreign bodies, Bronchoscopy, Anesthetic, Child