Anterior-Commissure Laryngoscope Extraction of Esophageal Coins in Children Using an Apnea Technique

Abstract

Objectives:

(1) To evaluate the efficacy and safety of coin extraction with the anterior-commissure laryngoscope during apnea in children less than 10 years old. (2) To present the sociodemographic characteristics of this population and analyze the differences in foreign body features. (3) To describe heart rates (HR), minimal O₂ saturation, and end-tidal CO₂ (ETCO₂) during the procedure.

Methods:

In this retrospective chart review study, consecutive patients with a diagnosis of cervical esophageal coin who underwent this procedure between May 2011 and December 2013 at our institution (n = 59) were evaluated and data analyzed. Age (independent variable) was categorized as ≤1, >1 and <5, ≥5 and ≤10 years old.

Results:

The mean and standard deviation (SD) of age was 3.1 ± 2.4 years. The majority were Medicaid participants (87.5%). We successfully removed the coin in 94.9% (n = 59) of our cases with this technique. Among children completing the technique, children ≤1 year of age were more likely to ingest pennies (100%), whereas children ≥5 years old more likely ingested quarters (50%; P = .01) Younger children showed higher HR than older groups and baseline values were similar to intraoperative ones (P < .001). The length of apnea was 57.7 ± 25.2 seconds. The median minimum O₂ saturation was 99.5% (min 93, max 100), and the media and SD of the ETCO₂ at the end of the procedure was 35.7 ± 4.8 mm Hg.

Conclusions:

In properly selected patients the anterior-commissure apnea technique represents an efficient and secure modality for treatment. If successful, the patient can be safely discharged home after clearance from anesthesia and a PO trial.