Esophageal Foreign Body

Patient Considerations

  • Disease Specific Considerations:

    • FB removal is common among children with peak ages ranging from 6 months to 6 years.

    • The child may be experiencing cough or heavy oral secretions, drooling, vomiting, wheezing, or respiratory distress.

    • Patients with esophageal foreign bodies should be considered to be a full stomach.

    • Button batteries are a true emergency.

      • Esophageal tissue can contact both sides of the battery leading to discharge.

        • This may lead to severe tissue damage and may lead to catastrophic blood loss if the aorta is perforated.

Case Planning

  • Specific or Unique Room Set-Up Requirements

    • Airway: cuffed ETT taped to side of surgeon’s preference

    • Drugs/Infusions: Induction agent and muscle relaxation for RSI.

    • Monitors: standard

    • Equipment: have a pair of Magill Forceps available in case the FB is obstructing the airway.

      • Securing the airway and preventing aspiration takes priority! Do NOT remove the FB unless it is preventing intubation.

  • Anesthetic Considerations

    • Induction: Plan for a rapid sequence induction.

    • Positioning: supine, shoulder roll

    • Maintenance: volatile anesthetic

      • Sevoflurane or titrate Propofol or Propofol drip.

      • No specific Hemodynamic/Physiologic goals

      • Surgical Considerations: minimal EBL (<10ml), paralytics not needed unless requested.

    • Emergence/Disposition: awake extubation

    • Post-Op Pain Management: pain scale low (3-4). > 2 years Toradol (0.5mg/kg) or Tylenol (10-15mg/kg PO q 6 hour) for pain control in PACU.

    • Case-Specific Complications: This child may be experiencing cough or heavy oral secretions. Have suction ready.

      • Consider glycopyrrolate

    • Surgeon Specific Considerations

      • Securing the airway takes priority, do not remove the FB yourself unless it is preventing intubation.

        • The surgeons cannot bill for FB removal if they are not present for removal

        • Sharp or irregular shaped FBs may have elements embedded in the esophagus. Unskilled removal can lead to tissue damage.