|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 241
Live foreign bodies in the airway
Seema Thukral, Priyanka Gupta, Archna Lakra, Amandeep Cheema
Department of Anaesthesia, ESI Hospital, Okhla, New Delhi, India
|Date of Web Publication||27-May-2015|
14, Himvihar Apartment, Plot No. 8, I.P. Extension, New Delhi - 110 092
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thukral S, Gupta P, Lakra A, Cheema A. Live foreign bodies in the airway. Astrocyte 2014;1:241
Upper airway obstruction may rarely complicate anesthesia practice especially in developing nations of the world, leading to disastrous consequences. Reports of endogenous and exogenous foreign bodies in the airway and breathing circuit are available in the literature. Adult worm resides in the gastrointestinal tract, and it may migrate to the esophagus and oropharyngeal cavity when irritated by certain drugs or anesthetic agents. Respiratory obstruction has been reported in a pediatric patient intubated with non-cuffed endotracheal tube who was known case of ascariasis. ,,, We encountered such a situation during induction of anesthesia in a child resulting in a disastrous complication.
A 9-year-old male child with a diagnosis of intestinal obstruction was posted for emergency laparotomy. Anesthesia was planned and executed using rapid sequence induction. As the Suxamethonium induced fasciculations disappeared, laryngoscopy was performed. To our surprise a thread like cylindrical moving object (Ascaris lumbricoides) was seen coming out at the level of pharynx. Soon another thread like structure appeared near the laryngopharynx followed by few more worms. An attempt was made to remove the worms with Magill's forceps that proved to be technically difficult as worms were slippery and moving. Intubation was tried, but worms were coming in the way and were being dragged with the tube. Assessing the gravity of this situation, oxygen insufflation with a nasal catheter was started, meantime more worms appeared occluding the glottic aperture. Attempts to remove the worms using Magill's forceps failed. Child did not regain spontaneous ventilation during all these attempts. Mask ventilation and supraglottic devices were avoided intentionally due to fear of worms entering into the trachea. Oxygenation by face mask was continued. Cricothyroidotomy was planned, but a fresh bunch of worms appeared and child started desaturating. Glottic aperture could not be visualized child had cardiac arrest. Cardiac massage was started. Despite of the best resuscitative efforts, child could not be revived.
This letter highlights the need for routine deworming of all the patients especially the children before elective surgery in the areas of endemic parasitic infestation. It should always be kept in mind at the time of induction, especially if the patient is of pediatric age group as ascariasis is a common infestation world-wide, especially in the age group of 5-15 years.  Cricothyroidotomy set and tracheostomy set must be immediately available in the operating room, a rigid bronchoscope is required if worms migrate to trachea and lower airways. If worms are seen coming out of the esophagus continuously, cricoid pressure should be applied in an effective manner and hence so that further exit of the worms is hindered and if possible patient should be intubated with a cuffed endotracheal tube and extubation should be done only when all airway reflexes are present.  In addition to this, Magill's forceps with gauge pieces wrapped at both the grasping ends, should be kept ready in the operating room to catch such kind foreign bodies.
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