# Anaesthetic Management of Foreign Body Bronchus at University Teaching Hospital of Nepal: An Observational Study

## TL;DR

This study examines anesthetic practices and complications during rigid bronchoscopy for foreign body removal in Nepal, highlighting common challenges and outcomes.

## Contribution

The study provides insights into current anesthetic practices and intraoperative complications specific to foreign body bronchoscopy in a Nepalese hospital setting.

## Key findings

- Desaturation was the most common intraoperative complication, occurring in 70.73% of cases.
- About 56.10% of patients required postoperative mechanical ventilation.
- Intravenous anesthesia with muscle relaxants was the most common technique used for induction and maintenance.

## Abstract

Rigid bronchoscopy is the preferred method for extracting airway foreign bodies, as it allows grasping forceps to extract foreign bodies while maintaining ventilation through a side port. The main challenge to the Anesthesiologists is to maintain oxygenation and ventilation while sharing the common field with the surgeons. This study intends to evaluate our current practices, challenges, and intraoperative events to enhance patient safety during these procedures.

This is a prospective observational study that included patients with suspected or confirmed bronchial foreign bodies who underwent rigid bronchoscopy from February 2023 to February 2025. Data were collected by the anesthesiologists using the structured proforma, covering the anesthetic technique, complications, and details of foreign bodies. SPSS version 22 was used for analysis.

A total of 41 rigid bronchoscopies were performed, including three repeat procedures. Intraoperative complications included desaturation in 29 (70.73%), vocal cord edema in 16 (39.02%), slipping of foreign body in 8 (19.51%), and both bradycardia and airway bleeding in 6 (14.63%) cases each. Postoperatively, 23 (56.10%) patients required mechanical ventilation, and one (2.44%) patient experienced cardiac arrest. During preoperative preparation, intravenous glycopyrrolate and steroids were used in 38 (92.68%) and 34 (82.93%) cases, respectively. For induction and maintenance, intravenous anesthesia was the most common technique, with muscle relaxants used in 39 (95.12%) cases. Of the 41 bronchoscopies, 30 (73.17%) achieved successful foreign body removal, while five (12.20%) required thoracotomy referrals.

Desaturation was the most common intraoperative complication. About half of the patient required mechanical ventilator postoperatively.