ORIGINAL ARTICLE 440 P J M H S Vol. 8, NO. 2, APR – JUN 2014 Removal of Foreign Body Coin from upper end of Oesophagus: Is general anaesthesia always needed? M. KHALID QAYYUM, ARSHAD FARZOOQ*, AKHTAR MUNIR**, MUHAMMAD SAJID*** ABSTRACT Aims: To evaluate whether removal of foreign body coin from upper esophagus always needs GA or can be safely removed under effect of topical anesthesia and to find quicker ,cost effective and safer method to combat this rapidly increasing pediatric emergency. Methods: This study comprising 138 cases of F.B coin upper end of esophagus presented to ENT department KMU- IMS Teaching Hospital Kohat during January 2010 to April 2013.Patients were aged from 3-7 years. Ninety were males and 48 were females. Removal of coin was tried in all cases after giving topical anesthesia with 2% lignocaine gel using McIntosh laryngoscope and 10 inches long serrated laryngeal forceps. In failed cases of extraction, a short GA was needed for extraction with laryngoscope or small oesophagoscope with same laryngeal forceps or esophageal forceps. Results: Successful removal of coin was conducted under effect of topical anesthesia in 94 cases while 44 cases needed a short GA, of these 44 cases, in 18 cases, coins were removed with laryngoscope and 10 inches long laryngeal serrated forceps while remaining 26 cases needed passage of small oesophagoscope. No bleeding or airway compromise observed during removal under topical anesthesia. Conclusion: Removal of coin from upper esophagus under effect of topical anesthesia is safe, quicker and cost effective. Keywords: Coin upper esophagus, topical anesthesia, general anesthesia INTRODUCTION Ingestion of the coins is becoming a frequent emergency in our country with introduction of two and five rupees coins. It is usually the lower end of the upper esophageal sphincter where most of the coins stuck and once this check post is passed, most of the coins go through rest of GIT to be expelled in feces. For removal of this stuck coin, different peoples adopted different approaches. Dahshan et al 1 favored bougienage to push the coin down and thought it to be safe, cost effective and shorter stay at hospital. Sandeep A et al 6 removed the coins using Foleys catheter and claimed it to be effective and safe. Bhargava and Brown 3 extracted the coins with forceps using succinylcholine and etiomedate for rapid succession intubation. Javed et al 8 who removed the foreign body coin which was stuck at upper end of esophagus in 82.1 % of their pedriatics group. They used general anesthesia, rigid esophagoscope and esophageal forceps except in 3 cases to whom they used magil forceps for removal of coins. ----------------------------------------------------------------------- *Associate Professor, ENT and Head& Neck surgery deptt. KMU–IMS, Kohat **Associate professor, Pathology Deptt. KMU-IMS, Kohat. ***Assoc. Prof. Pharmacology, KMU-IMS, Kohat Correspondence to: Dr. M. Khalid Qayyum, Associate Professor, Deptt. of ENT and Head &Neck surgery, KMU– IMS, Kohat METHODOLOGY One hundred and thirty eight cases of the coin upper end of oesophagus presented to ENT department of KIMS Teaching hospital, Kohat during January 2010 to April 2013.The patients were aged 3-7 years. Ninety were males and 48 were females. In all cases history of coin ingestion was given by either parents or patient. X- Rays of neck and chest were obtained in all cases. Coins stuck at upper end of esophagus were selected for removal. Lignocaine gel which tasted sweet was given to swallow. After mucosa was anesthetized in 7-10 minutes the patients were made to lie supine with one person holding the shoulders after wrapping the patient in a shawl, while another person holding head and neck stabilize the patient. Macintosh laryngoscope introduced and coin was extracted with a 10 inches long crocodile forceps. The procedure was tried only once and if failed, a short G.A was given for removal thus preventing the patient from getting injured by repeated attempts. RESULTS Coins were extracted from 94 children (68.1%), using McIntosh Laryngoscope and 10 inches long crocodile forceps after topical anesthesia with 2% lignocaine gel. Forty four patients needed general anesthesia, of these 44 cases, coin could be extracted in 18(13.1%) cases using McIntosh Laryngoscope and long