Efficacy and safety of spontaneous ventilation technique using dexmedetomidine for rigid bronchoscopic airway foreign body removal in children

Abstract

Background: In children, removal of an airway foreign body is usually performed by rigid bronchoscopy under general anesthesia. Debate continues regarding the respiratory mode (spontaneous or controlled ventilation) and appropriate anesthetic drugs. Dexmedetomidine has several desirable pharmacologic properties and appears to be a useful agent for airway surgeries.

Objectives: This study evaluates the efficacy of spontaneous ventilation (SV) technique using dexmedetomidine for bronchoscopic removal of foreign bodies in children.

Methods: Eighty pediatric patients undergoing rigid bronchoscopy for airway foreign body removal were randomly divided into two groups. In the SV group, dexmedetomidine (4 μg∙kg(-1)) and topical lidocaine (3-5 mg∙kg(-1)) were administered and the patients were breathing spontaneously throughout the procedure. In the manual jet ventilation (MJV) group, anesthesia was induced with fentanyl (2 μg∙kg(-1)), propofol (3-5 mg∙kg(-1)), and succinylcholine (1 mg∙kg(-1)), and MJV was performed.

Results: The success rates of foreign body removal, the incidence of body movement and other perioperative adverse events, and hemodynamic changes were similar between the two groups. The SV patients required longer stays in the postanesthesia care unit (P < 0.01) but experienced less coughing (P = 0.029) in the recovery room.

Conclusion: Dexmedetomidine may provide appropriately deep anesthesia and ideal conditions for rigid bronchoscopic airway foreign body removal without respiratory depression or hemodynamic instability.

Keywords: bronchoscopy; dexmedetomidine; foreign bodies; ventilation.