Exogenous foreign bodies in tracheobronchial tree particularly in children are common and challenging emergency for anaesthesiologist, paediatrician and otolaryngologist too. Common objects which may be inhaled are groundnut seeds, tamarind seeds, chikoo seeds, metallic pins1 etc. Normal protective cough reflexes prevent aspiration of these objects but occasionally, this reflex which is available to prevent foreign body from going in laryngotracheo bronchial tree, is not effective.

The performance of bronchoscopy for removal of foreign body, general anaesthesia is required. Though no ideal method has yet been developed for the same, the use of IV lignocaine together with Thiopentone for this purpose was recorded by Blancato et al.2 The depression of cough reflex by IV lignocaine, was demonstrated by Steinhouse et al.5 Steinhouse said, `lignocaine obtunds the pharyngeal and laryngeal reflexes without causing respiratory depression'. De, Clive louse et al have reported the use of IV lignocaine to provide analgesia. We decided to do a study of xylocaine spray with Ketamine, N2O; O2 and suxamethanium for bronchoscopy, for removal of foreign bodies in paediatric patients.

he prospective study was carried out in ENT Theatre at Seth GS Medical College and KEM Hospital and RN Cooper Hospital, Mumbai, in 100 patients and the age of the patients was less than 10 yrs.

Exclusion criteria was patients with lung complications like pneumonitis, atelectasis, pulmonary suppuration empyema, age less than 6 months.

Different types of FB were found are:-

1. Pea nuts
2. Chana
3. Whistle of toys.
4. Different kind of fruits.
5. Rathi seeds and
6. Safety Pins.

All patients underwent a thorough clinical examination with minimum Investigations like Hb/CBC, X-ray chest and ABG.

All the patients were premedicated with injection Glycopyrolate in the doses of 4 µg/kg; patients were wheeled into operation theatre, monitors were attached.

IV Isolyte P drip was started; patients were oxygenated with 100% oxygen for 3 minutes then general anaesthesia was begun with IV Ketamine 1-2 mg/kg body weight, 10% Xylocaine was sprayed after induction of anaesthesia. Scoline was introduced in the dosage 1-2 mg/kg body weight, as soon as twitches went off bronchoscopy was performed. During the procedure anaesthesia was maintained with the help of O2 + N2O and intermittent halothane, through a side arm of bronchoscope. Additional doses of intermittent scoline was injected IV as and when required, light plane of Anaesthesia was observed. During the entire procedure the pulse rate, BP, O2 saturation was monitored, ABG was done before and after the procedure. After the procedure patients were monitored till they became fully conscious and shifted to recovery room. They were observed for cyanosis, laryngospasm, bronchospasm and coughing.

Results were considered good if the patient has shown no significant changes in vital signs during bronchoscopy and the procedure could be performed with ease.
Results were considered as fair if the patient has shown changes in vital parameters and O2 saturation but within acceptable limits and bronchoscopy procedure was performed without difficulty.

It was considered as poor if there were some complications like bucking, coughing, laryngospasm which hampered bronchoscopy and needed some anaesthetic assistant.

	Demographic data Table 1 suggesting maximum number of patients belonging to age group of 6 months to 2 years of age. Next common age for foreign body was 2 to 4 years as shown in Table 2. The incidence of foreign body was going down as children were growing.

As per out study results were good in 60 patients. Table 3 the fair group of 30 patients have shown change in pulse rate of 10-20 beats/min. Average fall in O2 in saturation was observed between 10-20%, average change in blood pressure was 10-20 mm of Hg. In poor group 10 patients had complications like stridor, bucking and laryngospasm which needed extra dose of suxamethanium. Out of 10 patients one patient had cardiac arrest at the time of removal of foreign body, and reviewed. Shifted to ICU for ventilatory support and ICU care. Post operatively 4 patients had severe cough. Blood gas analysis did not reveal any hypercarbia or hypoxia.