Rigid and Flexible Bronchoscopy for Foreign Body Removal in Children: Complications, Risk Factors and Anesthetic Management.

Background: Foreign body (FB) aspiration is a typical emergency experienced by young children and associated with significant morbidity and mortality unless diagnosed early and treated adequately. Data on anesthetic management, applicability, complications and risk factors in the context of foreign body removal (FBR) is scarce, especially for flexible techniques, which are increasingly being used.

Aim: Analyzation of the complication rate and risk factors of two different techniques (rigid vs. flexible) as well as the anesthetic management for FBR in children.

Method: This is a retrospective single center analysis of 160 cases who underwent bronchoscopy for suspected FB aspiration under general anesthesia between January 2014 and January 2022 at a tertiary hospital.

Results: An FB was detected in 67 patients (median age 1.8 years). The preferred anesthesia regimes were total intravenous anesthesia (91.9%) and laryngeal mask (95%) for flexible bronchoscopy. Flexible bronchoscopy was used in 52.2%, rigid bronchoscopy in 31.3%, and both techniques were used in 16.4% of cases. The complication rate was 2.19 versus 1.29/patient in rigid versus flexible bronchoscopy, respectively. Independent risk factors for severe complications were rigid bronchoscopy (OR 11.6, p < 0.01) and airway infections (OR 4.1, p < 0.01). We observed flexible bronchoscopy being increasingly used for FBR during the observational period.

Conclusion: FBR can result in serious complications that require experienced pediatric anesthetic management. In our series, the use of a rigid bronchoscope and pre-existing airway infection were independent risk factors for severe complications. Flexible bronchoscopy was shown to be a safe, fast and successful tool for FBR with secured laryngeal mask airway and total intravenous anesthesia with fewer adverse events compared to rigid bronchoscopy.