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PEDIATRIC ANESTHESIOLOGY

The Risk Factors for Hypoxemia in Children Younger than 5 Years Old Undergoing Rigid Bronchoscopy for Foreign Body Removal

Lian-hua Chen, MD, PhD^*, Xu Zhang, MD^*, Shao-qin Li, MD^*, Yu-qi Liu, MD^*, Tian-yu Zhang, MD, PhD, and Jun-zheng Wu, MD, PhD

From the Departments of *Anesthesiology, and Otolaryngology, The Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; and Department of Anesthesiology, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio.

Address correspondence and reprint requests to Tian-yu Zhang, MD, PhD, Department of Otolaryngology, The Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China. Address e-mail to ty.zhang2006{at}yahoo.com.cn.

Abstract

BACKGROUND: Removal of an airway foreign body (FB) is usually performed by rigid bronchoscopy under general anesthesia, but the choice of anesthesia and ventilation techniques varies greatly among anesthesiologists and institutions. Hypoxemia is the most commonly observed adverse event during rigid bronchoscopy. It is influenced by a variety of factors including the patient's medical condition, the type of surgical procedure, and the anesthetic technique. In the current study, we investigated risk factors that statistically correlate with intraoperative or postoperative hypoxemia in young patients undergoing rigid bronchoscopy.

METHODS: From January 2007 to December 2008, 384 children younger than 5-yr-of-age subjected to rigid bronchoscopy for FB removal were included in the study. The detailed clinical information and perioperative adverse events were recorded. Surgical outcomes and incidence of perioperative adverse events were compared among different ventilation modes (spontaneous ventilation, manual intermittent positive pressure ventilation, and manual jet ventilation) and different anesthetic techniques (total IV anesthesia and inhaled anesthesia). An amalgamated dataset was used for the analysis of factors that correlated with perioperative hypoxemia.

RESULTS: In children who received total IV anesthesia with spontaneous ventilation during rigid bronchoscopy, we observed more intraoperative body movement and breath holding, significantly longer duration of emergence from anesthesia, lower percentage of successful FB removal, and more postoperative laryngospasm. Children in the manual jet ventilation group had the least occurrence of intraoperative hypoxemia. Five factors strongly correlated with intraoperative hypoxemia. Younger age, plant seed as the type of FB, longer surgical duration, pneumonia before the procedure, and spontaneous ventilation mode significantly increased the risk of intraoperative hypoxemia, whereas manual jet ventilation mode decreased it. Two factors were associated with postoperative hypoxemia: plant seed as a FB and prolonged duration of emergence from anesthesia.

CONCLUSION: We identified risk factors associated with intraoperative or with postoperative hypoxemia in rigid bronchoscopy which included patient age, type of FB, duration of surgical procedure, pneumonia before the procedure, ventilation mode, and duration of emergence from anesthesia. These results provide evidence that will help clinicians to reduce the incidence of hypoxemia in high-risk children.