Amnestic agents in pediatric bronchoscopy

Abstract

Study objective: To assess the risk for complications with the use of sedation and analgesia techniques in pediatric fiberoptic bronchoscopy.

Design: A retrospective case series.

Setting: The ICU of a 325-bed tertiary care research hospital.

Patients: Patients from 1 to 18 years of age who underwent fiberoptic bronchoscopy with BAL or transbronchial biopsy between June 1991 and December 1995 and received IV sedation and analgesia.

Interventions: None.

Methods: A retrospective chart review was performed. Extracted data included anesthetics and sedatives used and their per kilogram dosages, procedure durations, and complications including oxygen desaturations < 90%, vital sign alterations that required intervention, and emergence reactions to ketamine.

Results: A total of 103 bronchoscopies were performed on 64 patients. Ketamine was used as the primary anesthetic in 60 procedures (58%). A combination of fentanyl and midazolam was used in 38 of the 43 remaining procedures. A variety of combinations were used in the five remaining procedures. Complications occurred in 13 procedures and included oxygen desaturations, stridor, cough, apnea, and nasal bleeding. Twelve of the 13 complications occurred in patients with a diagnosis of HIV infection. Eight of the13 complications involved children < or = 3 years of age.

Conclusions: Pediatric bronchoscopy is a safe and valuable procedure. However, in this study, anesthetic selection was shown to adversely affect the complication rate in the subsets of children < or = 3 years of age and with an underlying diagnosis of HIV infection.