MANAGEMENT OF TRACHEOBRONCHIAL AND ESOPHAGEAL FOREIGN-BODIES IN CHILDREN - A SURVEY STUDY

Study Objective: To assess the current anesthetic management for aspir ation of a foreign body into the airway and esophagus of a young child . Design: Questionnaire study Measurements and Main Results: A questio nnaire regarding choice of induction. technique in a variety of foreig n body clinical scenarios was sent to 1,342 anesthesiologists, all mem bers of the Society for Pediatric Anesthesia. The foreign body, either a coin (penny) or a safety pin (open), was positioned on radiography in a variety of anatomic locations. Depending on the foreign body loca tion, the patient was either asymptomatic or exhibited symptoms. Parti cipants indicated their choice of induction for each situation. Of the 1,342 questionnaires mailed, there were 838 respondents (62.4%). Coin s and pins in the gastroesophageal tract were managed mostly by a rapi d-sequence induction (p < 0.001). Coins and pins at all levels in the tracheobronchial tree were managed most often by a mask induction with no cricoid pressure (p < 0.001). Although 14.5% of respondents chose awake and sedated technique for a foreign body in the supraglottic are a, few chose this technique for a for body in other locations. The typ e of object did not affect the choice of drugs for induction of anesth esia in most anatomic locations. Respondents with limited pediadric an esthesia experience used inhalation induction much less often than did those with more experience. Multiple-logistic regression analysis sho wed that both number of years in practice and type of practice (univer sity, private, hybrid) were predictors for the induction. Conclusions: These data indicate that inhalation induction is favored most often f or removal of foreign bodies in the airway, while intravenous inductio n is preferred for removal of foreign bodies in the gastroesophageal t ract. In addition, practice type, greater percentage of time spent in pediatric anesthesia, and greater experience are related to a higher l ikelihood of inhalation induction.