Abstract
Foreign body aspiration in children is a relatively common occurrence. However, the anesthetic management of foreign body removal may cause a variety of complications.
The following is a report on a case in which bilateral tension pneumothorax developed during the removal of a foreign body.
The patient was an 18-month-old boy and his history and preoperative x-ray confirmed that he had aspirated a peanut into his left bronchi. Removal of the wedged peanut was planned to be done under general anesthesia. After the insertion of a laryngeal mask airway (LMA) , a bronchoscope was injected through the LMA. Jet ventilation (JV) through a suction channel of the bronchoscope was employed to maintain the patient's ventilation. After several attempts to retrieve the peanut with a Fogarty catheter, hypotension and bradycardia occurred abruptly. SpO2 dropped to 40% simultaneously. Manual ventilation through the LMA was impossible. Pneumothorax was suspected and a catheter was immediately inserted into the left chest wall to deflate the air. An x-ray was taken and it showed the collapse of the bilateral lungs. After a catheter was inserted into the right chest wall, the ventilation was promptly restored. The removal of the foreign body was successfully performed two days later with PCPS on site.
We think the occurrence was caused by positive pressure ventilation which included JV—which may lead to air trappings. The risk of barotraumas and pneumothorax associated with positive pressure ventilation during the removal of foreign bodies should be kept in mind.
