Esophageal Foreign Body
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.
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.
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.
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.
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.