Rahşan ERCAN, Şenol EMRE, Güniz KÖKSAL, Güner KAYA, Fatiş ALTINTAŞ, Ayşe Çiğdem TÜTÜNCÜ, Özlem DİLMEN KORKMAZ

Çocuk hastalarda yabancı cisim aspirasyonu nedeniyle uygulanan rijid bronkoskopi sonuçlarımız

Amaç: Trakeal veya bronşiyal yabancı cisim aspirasyonu genel anestezi altında bronkoskopi gerektiren çocukluk çağının önemli acillerindendir. Bu geriye dönük çalışmada yabancı cisim aspirasyonu nedeniyle uygulanan bronkoskopiler; anestezi yöntemleri, riskleri ve işlem sonrası komplikasyonlar açısından değerlendirilmiştir.Gereç ve Yöntem: Çalışmaya Ocak 2006 ve Haziran 2011 yılları arasında çocuk cerrahisi ameliyathanesinde yabancı cisim şüphesiyle bronkoskopi yapılan çocuklar dahil edilmiştir. Dört yüz bir çocuk değerlendirmeye alınmış, tanı amaçlı bronkoskopi yapılanlar çalışmaya dahil edilmemiştir. Tüm bronkoskopilere genel anestezi uygulanmıştır. İnhalasyon veya IV indüksiyon ve idamesi, kendiliğinden solunum veya kontrollü mekanik ventilasyon şekli şartlara göre seçilmiştir. Hastalar klinik, fizik muayene, radyolojik bulgular, anestezi yöntemi ve komplikasyonlar açısından değerlendirilmiştir. Bulgular: Öksürük (%82) ve dispne (%21,8) trakeobronşiyal yabancı cisimlerin en sık belirtileri olarak tespit edilmiştir. En sık rastlanan radyolojik bulgular hava hapsi (%57) ve normal akciğer görünümü (%21) olarak bulunmuştur. Aspire edilen yabancı cisimlerin çoğunun fındık, fıstık, çekirdek gibi organik maddeler (% 80) olduğu görülmüş, sıklıkla sağ ana bronşa (%49,1) ve sol ana bronşa (%24,4) yerleşmişlerdir. Anestezi sırasında büyük komplikasyon olarak desaturasyon, aritmi, hiperkarbi ve bronkospazm saptanmıştır.Çıkarımlar: Yabancı cisim inhalasyonunda pek çok sorunla karşılaşılabilir, bu hastaların bronkoskopileri anestezi ve cerrahi açıdan doğru zamanda ve en güvenli şekilde, deneyimli anestezist ve cerrah tarafından yapılmalıdır.

Rigid bronchoscopies in pediatric patients with tracheobronchial foreign bodies: Our outcomes

Aim: Tracheal or bronchial foreign body aspiration is a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. The aim of this retrospective study was to evaluate the anesthetic management, hazards and complications of bronchoscopies performed because of suspicion of foreign body aspiration. Material and Method: We retrospectively analyzed the history, clinical and radiological findings and complications of 401 children admitted to the pediatric surgery department due to suspicion of foreign body aspiration between January 2006 and June 2011. Children requiring diagnostic bronchoscopies were excluded. All brochoscopies were performed under general anesthesia. Inhalation or IV induction and maintenance, spontaneous or controlled mechanical ventilation were selected individually according to the circumstances. Clinical findings, physical examination, radiological findings, anesthesia methods and complications of the patients were evaluated. Results: Cough (%82) and dyspnea (%21.8) were common symptoms of tracheobronchial foreign bodies. Most common radiological findings included air trapping (%57) and normal chest radiographs (%21). The aspirated foreign bodies were generally organic materials (%80) such as nuts, peanuts and seeds. The majority of foreign bodies lodged in the bronchial tree and the incidence of right sided (%49.1) foreign bodies was higher than that of the left sided (%24.4). Major complications during the anesthesia and postoperative period were desaturation, arrhythmia, hypercarbia and bronchospasm Conclusions: Many problems can be experienced in children with inhaled foreign bodies. Bronchoscopy must be performed under optimal conditions in these patients..

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