Resident Manual of Trauma to the Face, Head and Neck

ii. Esophagoscopy Symptomatic patients with suspected esophageal foreign bodies should undergo esophagoscopy. iii. Patient Monitoring Asymptomatic patients may be monitored if the retained object is not at risk of causing more injury. If the object has not passed from the esophagus after appropriate monitoring or is too large to pass through the pylorus, the object should be removed. b. Preparation It is important to maintain communication between the anesthesiolo- gist and the endoscopist to maximize patient safety. Make sure the proper equipment is available and functioning before bringing the patient into the operating room. If the center is inadequately equipped or staffed for this particular type of case and the patient is stable, arrange for transferring the patient to another hospital. i. Bronchoscope and Esophagoscope Assemble both a bronchoscope and an esophagoscope in the operating room. Some foreign bodies may become dislodged on induction or during the case, and either aspirated or swallowed unintentionally. Age-appropriate endoscopes should be prepared for the case, as well as an endoscope that is one size smaller than anticipated, in the event the aerodigestive tract is smaller than normal. Table 10.1 presents age- based guidelines for selecting bronchoscopes, laryngoscopes, and esophagoscopes for diagnostic endoscopy.

Table 10.1. Age-Based Guidelines for Selection of Bronchoscope, Laryngoscope, and Esophagoscope for Diagnostic Endoscopy Mean Age (Range) Bronchoscope Size* mm* Laryngoscope Size*

Esophagoscope Size*

Premature infant Term newborn (newborn to 3 mo.) 6 mo. (3–18 mo.)

2.5

3.7 5.8

8 8

4

3

4–5

3.5 3.7

5.7 6.3 6.7 7.6 8.2

9

5–6

18 mo. (1–3 yr.) 3 yr. (2–6 yr.) 7 yr. (5–10 yr.) 10 yr. (>10 yr. to adolescent

10.5

6

4 5 6

10.5–12

6–7

12 16

7 8

*Outside diameter given in millimeters. Source: Flint et al., Table 208-1.

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