[Current issues in the endoscopic treatment of tracheobronchial foreign bodies in pediatric age: personal observations].

The present paper reports some organizational hypotheses and presents personal experience in the endoscopic management of tracheobronchial foreign bodies in children. Many changes have taken place in endoscopy and anesthetic techniques over the last twenty years and these are reviewed. The present experience is based on data for 42 pediatric patients who had undergone tracheobronchial endoscopy from 1974 to 1994. Within this time lapse 3 separate periods have been identified-1974-1978, 1979-1990 and 1991-1994-for which there was a progressive improvement in endoscopic techniques. During the first period endoscopy was performed with the patient in apnea. During the second period endoscopy was able to last longer as the patient was periodically ventilated by means of the bronchoscope set in the trachea and by intermittently closing the proximal hole in the bronchoscope with a finger. During the third period endoscopy was made easier by the use of rod-lens telescopes attached to the forceps: this provided a better view when grasping the foreign body. Extractive tracheobronchial endoscopy requires close cooperation between anesthesiologist and endoscopist. As there is the risk of complications, the patient must be closely followed, not only during diagnosis and treatment but also post-operatively. For this reason parenteral administration of corticosteroids and antibiotics is advisable during the post-operative stage. Since extractive tracheobronchoscopy in pediatrics is still high risk surgery, the authors suggest three different solutions for the medical organization: a) The Pneumology-Bronchoscopy wards could be totally responsible for extracting the above-mentioned foreign bodies in children. b) An E.N.T.-Pneumological department could be set up aimed at improving rigid and flexible bronchoscope methods in both fields; this is suggested in view of the shortage of operating rooms in pneumology wards and the availability of E.N.T. specialists. c) The most important, most qualified E.N.T. wards (at least one for reach region) could be equipped with all the necessary tools. In this case the medical and paramedical staff would be kept up to date, also by attending bronchoscopy centers for adults. Hence the number of patients treated by each center would increase and the tracheobronchoscopic expertise of the E.N.T. specialists would improve. This would translate into a lowering of the risks and a better prognosis for these young patients.