Postoperative adverse respiratory events in preschool patients with inhaled foreign bodies: an analysis of 505 cases

OBJECTIVES: To identify the risk factors associated with postoperative adverse respiratory events in preschool-aged children with inhaled foreign bodies (FBs) undergoing rigid bronchoscopy. BACKGROUND: Foreign bodies aspiration is the most common cause of admission in pediatric emergency in otolaryngology service. Performance of rigid bronchoscopy is the standard treatment for removal of FBs in children. In some cases, severe respiratory events (complete laryngospasm and pneumothorax) may cause anesthesia-related morbidity and mortality. However, the association between patient-related factors and postoperative complications in preschool-aged children with inhaled FBs undergoing rigid bronchoscopy is unclear. METHODS: We carried out a large prospective, single-institution review of anesthesia for 505 American Society of Anesthesiologists I-III preschool children aged ≤7 with inhaled FBs undergoing rigid bronchoscopy. Patients with postoperative adverse respiratory events were classified into two groups: the minor events group [hemorrhage, minor desaturation, and partial laryngospasm (wheezing, stridor, and dyspnea)) and the major events group (complete laryngospasm, including major desaturation, and pneumothorax). RESULTS: The incidence of postoperative adverse respiratory events was 9.5% in preschool-aged children with inhaled FBs undergoing rigid bronchoscopy. Preoperative respiratory impairment was associated with an increased risk for the complicate (P < 0.01). Pneumothorax occurred in 4 (0.8%) patients. There was 1 (0.2%) death from severe respiratory-related complications. CONCLUSIONS: Preoperative respiratory impairment may develop the patients with FBs into postoperative adverse respiratory events.