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

Abstract

This is a case series with chart review of 59 consecutive pediatric patients with a diagnosis of cervical esophageal coin who underwent anterior-commissure laryngoscope (ACLA) extraction during apnea. The purpose of this study was (1) to evaluate the efficacy and safety of coin extraction and (2) to analyze foreign body features and intraoperative physiological parameters (apnea time, O₂ saturation and end-tidal CO₂ (ETCO₂) of apnea, minimum O₂ during procedure, and heart rate). The technique was completed in 94.9% of the sample. The mean of the length of apnea was 57.7 ± 25.2 seconds. The median minimum O₂ saturation was 99.5% (minimum = 93, maximum = 100), and the median of the ETCO₂ at the end of the procedure was 35.7 ± 4.8 mm Hg. Heart rates remained at baseline values during the procedure (P < .001). This technique represents an efficient and secure modality for treatment. If successful, the patient can be safely discharged after clearance from anesthesia and a swallowing trial.