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Very close co-operation is required between bronchoscopist and anaesthestist during the endoscopic removal of tracheobronchial foreign bodies. Securing the airway and maintaining adequate gas exchange in such patients can be difficult. Removal of inhaled straight needles may be a particular challenge because they may migrate into deep segmental bronchi. We report a successful removal of a straight needle from a subsegmental bronchus using using a fibreoptic bronchoscope through a laryngeal mask airway (LMA).
A 159 cm, 42 kg, 17-year-old female ASA physical status I patient had inhaled a turban pin 15 days prior to presentation. The foreign body was confirmed by posterior-anterior and lateral chest radiography to be in the anterior basal bronchus of the right lower lobe (Figure 1a, 1b). Two previous attempts at removal of the pin using a rigid bronchoscope had been unsuccessful. Even a thoracotomy and bronchotomy had been unsuccessful in removing the pin. We planned another approach using a flexible fibreoptic bronchoscope. With standard monitoring, anaesthesia was induced with propofol 2 mg/kg, fentanyl 2 [mu]g/kg and atracurium 0.5 mg/kg. Anaesthesia was maintained with sevoflurane...