Tracheobronchial foreign body removal in infants who had very small airways: A prospective clinical trial

Background and Aims Tracheobronchial foreign body aspiration is a life-threatening emergency. Using a rigid bronchoscope with optical forceps is the most effective method for foreign body removal. However, occasionally for some infants these instruments could not be used, as they may be too large for their small airways. Here, they present the apnea technique with only an optical forceps for foreign body removal in infants with very small airways. Methods Foreign bodies were removed using only an optical forceps for infants who had very small diameter airways. After general anesthesia, the suspension laryngoscope was set just above the vocal cord, and the inserted ventilation tube was pulled out, followed by a new one being inserted through the suspension laryngoscope and placed at the trachea. With the oxygen saturation at 100%, we pulled out the ventilation tube and inserted the optical forceps with an endoscope. After that, the foreign body was removed by the optical forceps. Results The foreign body removal using only an optical forceps is technically feasible for an infant. The mean operation time was 40.33 ± 8.06 min, and the hospital stay was 2.25 ± 0.62 days. When we pulled out the ventilation tube, the O2 saturation mean time (apnea time) was 106.25 ± 14.30 sec. In 12 infants, the foreign body was removed completely without a need for a second procedure. Conclusions The apnea technique for the removal of foreign body from the airway, using only an optical forceps with an endoscope, is useful in infants who had very small airways.