Pediatric rigid bronchoscopy and foreign body removal during
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An 8-year-old boy who presented with foreign body aspiration. He had a week-long history of cough and respiratory symptoms that began after eating sunflower seeds. The patient had no other symptoms of COVID-19 disease at the time (no fever, sore throat, rhinorrhea) but did have paroxysmal coughing and shortness of breath. A lateral neck X-ray and chest X-ray had revealed a large opaque foreign body consistent with a seed located in the upper trachea. The patient was noted to have increased work of breathing, and biphasic stridor was noted throughout the chest.

The patient was brought to the operating theatre wearing a standard surgical mask for droplet precautions. Anesthesia was performed with an intravenous technique, maintaining spontaneous ventilation. Laryngoscopy was performed. A size 5×30 cm rigid bronchoscope (Storz) was advanced into the airway, and a large sunflower seed was identified, lodged at the inferior aspect of the cricoid cartilage. The seed was so large it could only transit between the inferior border of the cricoid cartilage and the carina. The optical forceps could only grasp the seed at it's front aspect as the seed was so large; it could not be withdrawn completely into the bronchoscope. The seed, forceps, and bronchoscope were all removed from the trachea and the larynx together, however, once past the glottis the seed was inadvertently dropped into the oropharynx.

The patient was intubated in order to ensure the foreign body did not return to the airway. The standard anesthetic laryngoscope with Macintosh blade proved to provide sufficient exposure to visualize the foreign body and remove it with the optical forceps. Removing the foreign body from the oropharynx with the 36 cm optical forceps was successful, but cumbersome to perform. Repeat bronchoscopy assessment revealed no secondary foreign bodies.

After waiting 30 min for air exchange to be completed, the surgical team proceeded with doffing their personal protective equipment. Once doffing was complete, the patient was transferred to the recovery room where staff with appropriate PPE were present to take over care. The patient was subsequently transferred home in stable condition later that same day. The patient’s bronchial aspirate returned a “negative” result 3 days later.

Source: https://journalotohns.biomedcentral.com/articles/10.1186/s40463-020-00464-z
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