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EMERGENCY BRONCHOSCOPY FOR TRACHEOBRONCHIAL STONE ASPIRATION IN A CHILD - A GOOD RECOVERY EXPERIENCE WITH ROCURONIUM-SUGAMMADEX AND DILUTED LIDOCAINE IRRIGATION OF THE AIRWAYS
Author(s): ,
Caliskan, E.
Affiliations:
Baskent University- School of Medicine- Adana Research and Education Center, Anesthesiology and Reanimation, Adana, Turkey
,
Yalcin Cok, O.*
Affiliations:
Baskent University- School of Medicine- Adana Research and Education Center, Anesthesiology and Reanimation, Adana, Turkey
Aribogan, A.
Affiliations:
Baskent University- School of Medicine- Adana Research and Education Center, Anesthesiology and Reanimation, Adana, Turkey
ESRA Academy. Çok OY. Sep 13, 2017; 190706; 338 Topic: Local anaesthesia
Assoc. Prof. Oya Yalçın Çok
Assoc. Prof. Oya Yalçın Çok

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Abstract
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Background and Aims:

Tracheobronchial foreign body aspiration is one of causes of chilhood morbidity and mortality. Early  and unproblematic removal of foreign body may be life-saving.  Hereby, we present our experience with rocuronium-sugammadex and diluted lidocaine spray in a child  who underwent emergency bronchoscopy due to stone aspiration.

Methods:

A 8-year old, 19 kg girl with mental retardation and ventriculo-peritoneal shunt admitted  for suspected stone aspiration. Physical examination revealed stridor, increased respiratory rate, decreased ventilation on her right side, chest X-ray demonstrated unilateral air-trapping. Anaesthesia was induced with midazolam 1mg, atropine 0.02mgkg-1 iv and sevoflurane via mask preserving spontaneus ventilation. Due to the nature of the foreign body, its possible injury to the trachea while removing and subsequent possibility of irritable airway, we pre-conditioned the airway with topical lidocaine 10% spray diluted  with a 1:4 ratio with saline to increase the volume and decrease toxicity risk. Six doses, approximately 15 mg washed the entire airway before starting the bronchoscopy. Rocuronium 0.4 mgkg-1 was administered to facilitate the procedure and followed by sugammadex 2 mgkg-1 after 10 minutes when the stone was removed. TOF monitorization  was evaluated as 0.96 at 12thmin. 

Results:

No complications such as bronchospasm, irritable airways or excessive coughing occurred peri/postoperatively. 

Conclusions:

The clinician should practise a safe and practical combination of techniques for rigid bronchoscopy procedures. Here, we suggest that a quick reversal plan with rocuronium-sugammadex in combination with topical use of local anaesthetics diluted for paediatric patients should be considered to decrease airway irritation and reactivity during perioperative period of emergent bronchoscopy.

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