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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
2.5
3.7
8
4
Term newborn
(newborn to 3 mo.)
3
5.8
8
4–5
6 mo. (3–18 mo.)
3.5
5.7
9
5–6
18 mo. (1–3 yr.)
3.7
6.3
10.5
6
3 yr. (2–6 yr.)
4
6.7
10.5–12
6–7
7 yr. (5–10 yr.)
5
7.6
12
7
10 yr. (>10 yr. to
adolescent
6
8.2
16
8
*Outside diameter given in millimeters. Source: Flint et al., Table 208-1.