Question

Write briefly about anaesthesia techniques for such patients.

Hint:

Careful airway management and adequate anesthesia are crucial during bronchoscopy to prevent complications such as airway obstruction, hypoxia, or aspiration.

Answer 1

Anesthesia for children undergoing bronchoscopy to remove a foreign body must be carefully managed to ensure airway safety, adequate muscle relaxation, and minimal complications. The key anesthesia techniques for such patients include:
1. Preoperative Assessment:
- A thorough history and physical examination should be performed to assess the child’s overall health and airway status.
- Preoperative fasting: Ensure the child has been appropriately fasted before the procedure to reduce the risk of aspiration during anesthesia.
2. Anesthesia Induction:
- Intravenous (IV) induction with agents like propofol or thiopental is commonly used for a smooth induction of anesthesia in children.
- Mask induction: In some cases, especially in younger children, inhalational induction with sevoflurane or desflurane can be used to ease the process.
- Endotracheal Intubation: General anesthesia is maintained with a cuffed or uncuffed endotracheal tube (ETT), which helps secure the airway during the procedure.
3. Maintenance of Anesthesia:
- Balanced anesthesia: Maintenance is achieved with a combination of inhalational agents (sevoflurane, desflurane) and intravenous agents like remifentanil for analgesia and rocuronium or vecuronium for muscle relaxation.
- Ventilation: Positive pressure ventilation is maintained throughout the procedure, ensuring adequate oxygenation and ventilation.
4. Airway Management:
- Rigid bronchoscopy requires secure airway management to avoid inadvertent displacement of the tube or airway obstruction. The anesthesiologist ensures that ventilation is stable and that the airway remains protected during the procedure.
- Monitoring: Continuous monitoring of oxygen saturation, end-tidal CO2, and heart rate is essential during the procedure.
5. Postoperative Care:
- Extubation: After the foreign body is removed, the child is carefully extubated once fully awake and able to maintain their own airway.
- Recovery: The child is monitored in a recovery room for any respiratory distress or complications such as laryngospasm or bleeding.