A CASE OF FOREIGN BODY RIGHT LOWER BRONCHUS REMOVED BY RIGHT POSTERO-LATERAL THORACOTOMY TAKEN UNDER GA

Director : Dr.Ganesh Prabu M.D,D.AProf : Dr.Thirunavukkarasu M.D,D.AAsst Prof : Dr. Pappiah M.D,D.A PG : Dr Rajamurugan DA IIyr

A 4 years old female child weighing 13 kg with history of cough for 15 days, not responding to antibiotic and antitussive treatment was brought to our hospital.* Hx of intermittent fever for 5 days relieved by medication.* No history of choking/ noisy breathing/vomiting/ cyanosis/breathing difficulty.O/E child was comfortable with decreased breath sounds in Right lower lung base.Rest of examination was unremarkable.

•Lab investigations: Hb-10.8 gms% BT-2 mins 30 sec CT-3 mins Blood group: O positive B.Urea: 18 mgs/dl S.Creatinine:0.8 mgs/dl

CXR- shows right lower lobe collapse with FB in lower bronchiole.

•On 17/11/2012 Bronchoscopic removal attempted Procedure deferred since there was

bleeding while handling airway and fall in O2 saturation

Baby shifted to Intensive Respiratory Care Unit(IRCU) for observation

•CT Chest showed right middle and lower lobe collapse

•On 20/11/2012 Cardiothoracic opinion obtained. Planned for Right postero-lateral

Thoracotomy, if rigid broncoscopic removal fails in cardiothoracic operating room.

Child assessed under ASA I

•Preop: Child conscious,active HR-130 bpm RR-28/min SPO2-98% in room air CVS- S1S2 + RS-NVBS+ AE I in Right

lower zone

•On 21.11.2012 IV lines secured in Right forearm and Right

EJV Induced with Inj Thiopentone 50 mg,Inj

Fentanyl 50 mcg,Inj Suxamethonium 20 mg Maintained with 100%O2,Sevoflurane,Inj

Vecuronium in titrated doses In Supine position,Rigid broncoscopic (Size

4)removal attempted Ventilated via side port Foreign body(LED bulb with prongs along

with granulation tissue visualised)couldn’t be removed since it was adherent

Child handed over to cardiothoracic team

•Child intubated with 4.5 mm cuffed ET tube and connected to Jackson-Ree’s circuit

•Initially child positioned in left lateral position,

due to fall in O2 saturation,child changed to prone position

•Capnometry connected and child ventilated with ETCO2 <40mm Hg

After adequate attempts,child reversed and extubated•Postop: Child conscious, obeying mild Tachypnoeic HR-142 bpm RR-30/min SPO2-97% with O2 mask

(6L/min) CVS-S1S2+ RS-NVBS+, B/L crepts Right side ICD in situ

Postoperative instructions •IVF•Inj Cefotaxime 500mg iv BD•Inj Ampicillin 500mg iv BD•Inj Deriphylline ½ cc iv BD•Inj Ranitidine ½ cc iv BD•Nebulisation with Budecort BD•Nebulisation with Asthalin B•Paracetamol suppository sos

•On 25.11.12, Hb-12.4 gms%•X-ray Chest 26.11.12- clear 27.11.12- lung expansion good•ICD removed on 29.11.12•Child discharged on 4.11.12 in a stable

condition.