{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:46:54Z","timestamp":1780469214530,"version":"3.54.1"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T00:00:00Z","timestamp":1712620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32GM108554\u201011"],"award-info":[{"award-number":["5T32GM108554\u201011"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anesthesia is required for endoscopic removal of esophageal foreign bodies (EFBs) in children. Historically, endotracheal intubation has been the de facto gold standard for airway management in these cases. However, as more elective endoscopic procedures are now performed under propofol sedation with natural airway, there has been a move toward using similar Monitored Anesthesia Care (MAC) for select patients who require endoscopic removal of an EFB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single\u2010center retrospective cohort study, we compared endoscopic EFB removal with either MAC or endotracheal intubation. Descriptive statistics summarized factors stratified by initial choice of airway technique, including intra\u2010 and postanesthesia complications and the frequency of mid\u2010procedure conversion to endotracheal intubation in those initially managed with MAC. To demonstrate the magnitude of associations between these factors and the anesthesiologist's choice of airway technique, univariable Firth logistic and quantile regressions were used to estimate odds ratios (95% CI) and beta coefficients (95% CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the initial search, 326 patients were identified. Among them, 23% (<jats:italic>n<\/jats:italic>\u2009=\u200975) were planned for intubation and 77% (<jats:italic>n<\/jats:italic>\u2009=\u2009251) were planned for MAC. Three patients (0.9%) who were initially planned for MAC required conversion to endotracheal intubation after induction. Two (0.6%) of these children were admitted to the hospital after the procedure and treated for ongoing airway reactivity. No patient experienced reflux of gastric contents to the mouth or dislodgement of the foreign body to the airway, and no patient required administration of vasoactive medications or cardiopulmonary resuscitation. Patients had higher odds that the anesthesiologist chose to utilize MAC if the foreign body was a coin (OR, 3.3; CI, 1.9\u20135.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) or if their fasting time was &gt;6\u2009h. Median total operating time was 15\u2009min greater in intubated patients (11 vs. 26\u2009min, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that MAC may be considered for select pediatric patients undergoing endoscopic removal of EFB, especially those who have ingested coins, who do not have reactive airways, who have fasted for &gt;6\u2009h, and in whom the endoscopic procedure is expected to be short and uncomplicated. Prospective multi\u2010site studies are needed to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14888","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T10:54:28Z","timestamp":1712660068000},"page":"628-637","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Natural airway as an alternative to intubation for pediatric endoscopic esophageal foreign body removal: A retrospective cohort study of 326 patients"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9953-8844","authenticated-orcid":false,"given":"Hannah","family":"Lonsdale","sequence":"first","affiliation":[{"name":"Division of Pediatric Anesthesiology, Department of Anesthesiology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Shargo","sequence":"additional","affiliation":[{"name":"Morsani College of Medicine University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Ekblad","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Dolan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Fierstein","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research Institute Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"},{"name":"Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Miller","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Shared Resource, Institute for Clinical and Translational Research Institute Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditi","family":"Dey","sequence":"additional","affiliation":[{"name":"Maternal Fetal Neonatal Institute Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6432-0554","authenticated-orcid":false,"given":"Jacquelin","family":"Peck","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesia Joe DiMaggio Children's Hospital  Hollywood Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Rehman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology and Pain Medicine Johns Hopkins All Children's Hospital  St. Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Wilsey","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Johns Hopkins All Children's Hospital  St.\u00a0Petersburg Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-1988"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/pg9.0000000000000168"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003143"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000729"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.01.030"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-006-1819-0"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(10)61193-2"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000995"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/pcc.0000000000000504"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922809337529"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14539"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.5223\/pghn.2021.24.1.100"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12549"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12207"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004310100788"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003121"}],"container-title":["Pediatric 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