Foreign Body in the Bronchus Intermedius: Inadvertent Deployment of a Bravo Wireless pH Probe in the Airway.

The Bravo pH probe is a wireless capsule allowing remote quantification of gastroesophageal reflux. A 14-year-old male presented for Bravo probe placement. Following esophagogastroduodenoscopy, attachment of the Bravo probe was attempted. Immediately, the patient began coughing without oxygen desaturation. Repeat endoscopy did not reveal the probe within the esophagus or stomach. He was then intubated, and fluoroscopy demonstrated a foreign body within the bronchus intermedius. Rigid bronchoscopy was performed to retrieve the probe using optical forceps. This is the first case of pediatric inadvertent airway deployment requiring retrieval. We recommend endoscopic visualization of the delivery catheter entering the cricopharyngeus before Bravo probe deployment, then followed by repeat endoscopy to confirm position of the probe after attachment.

Postoperative Pain and 14-Day Recovery in Children Undergoing Adenotonsillectomy: Low Thermal Damage Device Versus Electrosurgery.

This was a randomized controlled trial of low thermal damage device versus traditional electrosurgery in children 3 to 17 years old with a clinical diagnosis of sleep disordered breathing, obstructive sleep apnea with adenotonsillar hypertrophy, or recurrent adenotonsillitis. Pain score (Wong-Baker FACES pain scale) was recorded each morning before eating, drinking, or administering pain medication for 14 days postoperatively. Seventy-five children were enrolled. There was no difference in the rate of decrease in pain scores. A significant interaction between rate of pain decrease and number of pain medication doses was present ( P < .0001). Median number of pain medication doses was greater with electrosurgery (36, range: 7-49) versus low thermal device (21, range: 2-124; P = .001). Pain scores reached 0 after a median of 7 days (95% confidence interval [CI], 5.2-8.6) for low thermal device and 9 days (95% CI, 8.0-10.0) for electrosurgery ( P = .67). One child randomized to electrosurgery was withdrawn due to hospitalization for postoperative bleed. In children, low thermal device results in significantly less pain medication used during the postoperative period than electrosurgery.

The use of veno-venous extracorporeal membrane oxygenation for perinatal support of an infant with d-transposition of the great arteries, intact atrial and ventricular septa, and flow-restricted ductus arteriosus.

Prenatal assessment of a fetus with D-transposition of the great arteries demonstrated an absence of mixing between systemic and pulmonary circulations, and predicted lethal postnatal hypoxemia. A multidisciplinary meeting evaluated therapeutic options. After cesarean delivery, veno-venous extracorporeal membrane oxygenation was instituted in preparation for open atrial septectomy. The infant subsequently underwent an arterial switch procedure. Prenatal delineation of pulmonary and systemic circulations in the fetus with D-transposition of the great arteries influences postnatal management. Multidisciplinary planning enhanced the perinatal outcome.