Gas induction. Maintain spontaneous ventilation. Adequate depth of anaesthesia
(+/- check ventilation – risk of pushing FB distally. Avoid insufflation of stomach)
Spray cords with lignocaine
Insert uncuffed nasal (standard) ETT to level just above cords
+/- close mouth as required
Spontaneous ventilation of O2+anaesthetic vapour. PEEP on T-peice
Also see: https://anaesthesiaonreflection.wordpress.com/2014/12/05/paediatric-airway-surgery-recipe/
Remember basic manoeuvres e.g. Abdominal thrusts, Heimlick Manoeuvre, back blows.
In the event of cardiac arrest CPR/chest compressions may dislodge the foreign body.
Misc learning points
delegate a scribe during the event if possible
notes – should be comprehensive, contemporaneous, accurate. MDT
Involve seniors & MDT
Breaking bad news with family: Team approach. Be honest & open. Avoid information overload, may need second meeting. Single spokesperson. Reassure pt not in pain or aware.
Debrief of whole team after the event. Ideally with somebody adequately trained and ‘3rd party’
Discuss with MPS/MDU if necessary
If it is down the right main bronchus (which it usually is)…
Cut off the distal connection of suction tubing and pass down the ETT/tracheostomy (size 8+)
Also a possibility is to connect to oral ETT and advance into right main bronchus
This gives wide bore suction.
When preparing sux for paeds case have syringe attached to a needle for emergency sublingual/IM injection if needed.