## Anesthetic Induction for Foreign Body Airway Removal ### Why Ketamine is the Drug of Choice **Key Point:** Ketamine is the preferred induction agent for foreign body airway removal in pediatric patients because it preserves airway reflexes and maintains spontaneous ventilation. **High-Yield:** In foreign body aspiration, maintaining spontaneous breathing is critical — if the foreign body is dislodged during induction, the child can still cough it out or maintain oxygenation. Ketamine achieves this better than other agents. ### Mechanism & Advantages | Property | Ketamine | Propofol | Thiopental | Etomidate | |----------|----------|----------|-----------|----------| | **Airway Reflexes** | Preserved | Abolished | Abolished | Preserved | | **Spontaneous Ventilation** | Maintained | Depressed | Depressed | Maintained | | **Airway Tone** | Maintained | Decreased | Decreased | Maintained | | **Hemodynamic Stability** | Excellent | Poor | Poor | Excellent | | **Emergence Delirium** | Yes (mitigated in children) | No | No | No | **Clinical Pearl:** Ketamine's dissociative properties and preservation of protective airway reflexes make it uniquely suited for airway instrumentation in children. Even if the foreign body shifts during induction, the child retains the ability to protect the airway. **Mnemonic:** **KEEPS** — Ketamine Excellent for Emergency Pediatric Situations (airway protection) ### Dosing in Pediatric Foreign Body Removal - **IV induction:** 1–2 mg/kg IV (preferred for rapid sequence) - **IM induction:** 4–5 mg/kg IM (if IV access difficult) - Onset: 30–60 seconds IV; 3–5 minutes IM - Duration: 10–15 minutes **Tip:** Pre-oxygenation for 3–5 minutes is essential before induction to maximize oxygen reserves in case of apnea or airway obstruction.
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