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CHALLENGES OF RIGID BRONCHOSCOPY FOR FOREIGN BODY RETRIEVAL IN A PREGNANT WOMAN
ESRA Academy. Tan Z. Sep 8, 2016; 138247; 0065 Topic: Obstetric Population
Dr. Zihui Tan
Dr. Zihui Tan

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Abstract
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Background and Aims:

Surgery in the pregnant population is uncommon. Rigid bronchoscopy is especially challenging in this group of patients who are at risk of pulmonary aspiration and difficult airway. There is currently no case reports of this procedure performed in the obstetric population.


Methods:

A 30 years old female was 30 weeks into gestation when she presented after inhaling a sewing pin. She was subsequently scheduled for rigid bronchoscopy for foreign body removal. Pre-operatively, she was counselled for risks of preterm labour, aspiration and awareness. Aspiration prophylaxis was given. Intravenous midazolam and glycopyrolate were given and her airway was topicalised in the induction room. A further 2mg of midazolam and 20mg of ketamine was given and target controlled infusion (TCI) of propofol at 2mcg/ml was started. 


Results:

The surgeons inserted the rigid bronchoscope uneventfully. After passing the vocal cords, lignocaine was given via the bronchoscope. Oxygen was connected to the side port and she was tilted to a left lateral position. Throughout the surgery, her mean arterial blood pressure and saturation were maintained. Propofol TCI ran at 2.5-3mcg/ml. The patient reacted occasionally but this was quickly suppressed by deepening anaesthesia with boluses of propofol. The post-operative cardiotocography (CTG) was normal. Two months later, she had an uneventful delivery.

Conclusions:

Pregnancy is a known risk factor for aspiration. In addition, they have a lower functional residual capacity and higher oxygen consumption. We have demonstrated how such a procedure can still be done safely with preoperative preparation and intraoperative care involving a multi-disciplinary team.

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