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LETTER TO EDITOR
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 89-90

Point-of-care ultrasound as an aid to upper esophageal foreign body removal


1 Department of Truma and Emergency, All India Institute of Medical Science, Bhubaneswar, Odisha, India
2 Department of Anaesthesia, All India Institute of Medical Science, Bhubaneswar, Odisha, India
3 Department of ENT, All India Institute of Medical Science, Bhubaneswar, Odisha, India

Correspondence Address:
Dr. Chitta R Mohanty
Department of Trauma and Emergency, AIIMS, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_716_18

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Date of Web Publication28-Dec-2018
 


How to cite this article:
Mohanty CR, Singh N, Mehta S, Das S. Point-of-care ultrasound as an aid to upper esophageal foreign body removal. Saudi J Anaesth 2019;13:89-90

How to cite this URL:
Mohanty CR, Singh N, Mehta S, Das S. Point-of-care ultrasound as an aid to upper esophageal foreign body removal. Saudi J Anaesth [serial online] 2019 [cited 2019 Mar 21];13:89-90. Available from: http://www.saudija.org/text.asp?2019/13/1/89/248862



Sir,

Foreign bodies are common among the pediatric population. Plain radiograph AP view is the standard to diagnose and localize ingested or aspirated foreign body (FB). Most of the patients need either sedation or general anesthesia for FB removal depending on its position. Point-of-care ultrasound (POCUS) of the upper airway can be used for detection and also as a dynamic tool for monitoring the changes in the position of the FB during the attempt of its removal. It has been used for the localization and removal of soft tissue FB.[1] Here, we present a case of use of POCUS for upper esophageal FB removal.

A 3-year-old male child, 11 kg, presented to the emergency department with a history of ingestion of FB. The plan was to remove it under general anesthesia. Chest X-ray AP view confirmed a radio-opaque FB. He was premedicated with injection glycopyorrolate 0.1 μg, fentanyl 2 μg/kg, and inj. midazolam 0.5 mg iv. Ventilation was assisted with 50% oxygen and sevoflurane. Inj attracurium 0.5 mg/kg was administered, and trachea was intubated with cuffed size 4 endotracheal tube. The SonoSite M-Turbo ultrasound machine with linear 13--6 MHz transducer was used to confirm the location of FB [Figure 1]. It was removed with the help of esophagoscope. Initially, it was visible but was lost during manipulation. There was a doubt of the passage of FB down in the esophagus, but the ultrasound was suggesting its presence in the upper esophagus. Esophagoscope was repositioned and the FB was removed in the fourth attempt with minimal trauma. It is not rare to detect the FB in preprocedure X-ray, but finding nothing during exploration under anesthesia.
Figure 1: Radio-opaque foreign body (yellow arrow) inside esophagus (ESO); CCA: Common carotid artery; IJA: Internal jugular vein

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We suggest the use of POCUS before or after anesthesia, depending on the co-operation of the patient posted for FB removal. It will also avoid unnecessary radiation exposure in the pediatric population.[2] Further studies are needed to consider it as a part of FB management algorithm.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Varshney T, Kwan CW, Fischer JW, Abo A. Emergency point-of-care ultrasound diagnosis of retained soft tissue foreign bodies in the pediatric emergency department. Pediatr Emerg Care 2017;33:434-6.  Back to cited text no. 1
    
2.
Sejun J, Kwan C. Novel uses of point-of-care ultrasound for pediatric foreign bodies: An emergency department case series. J Emerg Med 2018;55:530-3.  Back to cited text no. 2
    


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