Pediatric anesthesia & critical care
Natural airway as an alternative to intubation for pediatric endoscopic esophageal foreign body removal: A retrospective cohort study of 326 patients
Authors' conclusion
This study demonstrates that MAC may be considered for select pediatric patients undergoing endoscopic removal of EFB, especially those who have ingested coins, who do not have reactive airways, who have fasted for >6 h, and in whom the endoscopic procedure is expected to be short and uncomplicated.
Study context
- Population
- Children undergoing endoscopic removal of esophageal foreign bodies under anaesthesia
- Participants
- 326 children
- Exposure
- Monitored Anesthesia Care (MAC) vs endotracheal intubation for endoscopic EFB removal
- MACn = 251
- Intubationn = 75reference
- Outcome
- Mid-procedure conversion to endotracheal intubation in patients initially managed with MAC
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
MAC
0.9%
3
Observational data: associations, not effects.
Further findings
Factors associated with anesthesiologist's choice of MAC: foreign body a coin
| OR (CI) | P value | ||
|---|---|---|---|
| CoinOdds that the anesthesiologist chose MAC · univariable Firth logistic regression | 3.3 (1.9–5.7) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
- Higher odds of MAC chosen if fasting time >6 h
Total operating time
- Median total operating time 15 min greater in intubated patients (11 vs. 26 min)
- P < 0.001
Safety
- Hospital admission for ongoing airway reactivity (converted MAC patients)
- 0.6% · 2
Reflux of gastric contents to mouth, foreign body dislodgement to airway, vasoactive medications or CPR
- No patient experienced any
Original publication
Natural airway as an alternative to intubation for pediatric endoscopic esophageal foreign body removal: A retrospective cohort study of 326 patients. Paediatr Anaesth. Published 9 April 2024. doi:10.
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