Risk Factors Of Intra-and Post-operative Desaturation During The Rigid Bronchoscope For Tracheobronchial Foreign Body Removal In Children

Objective To explore the risk factors of desaturation during and after the procedure of tracheobronchial foreign body(TFB) removal in children.Methods Three hundred and eleven children aged 5month to 12 year,ASAⅠorⅡgrade, undergoing emergency operation of airway foreign body removal during Feb.of 2007 and Oct.of 2008 in Shanghai Eye and ENT hospital were included in this study.Complications before the operation,Suspicious TFB persistence,the TFB type,the TFB location, ventilation mode,body movement at the insertion of the bronchoscopy,the operator, duration of operation,duration of emergence stage and the occurrence intra-and postoperative desaturantion were recorded.The decreasing of pulse oxygen saturation below 90%was considered as the occurrence of desaturantion.Univariate analysis and multivariate logistic regression analysis were used to examine the relations between these factors and the intra-and postoperative desaturation.Result The incidence of desaturation during and after the procedure was 20.3%and 11.9% respectively.Multivariate logistic regression analysis identified that the age distribution (OR=0.668,P=0.048),pneumonia before the procedure(OR=3.837,P=0.003),the TFB type of plant seeds(OR=2.654,P=0.027) and the long duration of operation(OR=7.069,P＜0.001) would increased the risk of intraoperative desaturation.As compared to intermittent positive pressure ventilation,the spontaneous respiration of ventilating mode increased the risk of intraoperative desaturation(OR=3.152,P=0.035)while the mannu jet ventilation decreased the risk of intraoperative desaturation(OR=0.161,P＜0.001).The TFB type of plant seeds(OR=3.678,P=0.027) would increased the risk of postoperative desaturation.As the duration of the emergence period prolonged,the risk of postoperative desaturation increased(OR=1.164,P＜0.001).Conclusion The age,pneumonia before the procedure,the TFB type,the ventilating mode and the duration of operation were the significant predictors for intraoperative desaturation while the TFB type and the duration of emergence period were the significant predictors for postoperative desaturation.Based on these predictors of intra-and postoperative desaturation,necessary measure can be taken to decrease the development of intra-and postoperative desaturaton in high risk children.