Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

Abstract

The objective of this research was to study the effectiveness and safety of proceduralist given sedation in pediatric flexible bronchoscopy. Flexible bronchoscopy was performed in all 267 patients. All patients received midazolam and/or ketamine. The median (interquartile range [IQR]) age of the studied population was 16 (18) months. The indication of bronchoscopy varied. The mean ± standard deviation (SD) dose of midazolam was 0.109 (0.03) mg/kg and that of ketamine was 1.17 (0.43) mg/kg. We observed minor side effects of procedural sedation. All patients underwent procedure successfully. Flexible bronchoscopy in children can be safely performed under sedation using a combination of midazolam and ketamine.

Keywords

flexible bronchoscopy - proceduralist - sedation

• References

• 1 Barbato A, Magarotto M, Crivellaro M. , et al. Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres. Eur Respir J 1997; 10 (08) 1761-1766
• 2 Laín A, Fanjul M, García-Casillas MA. , et al. [Airway foreign bodies removal with flexible bronchoscopy in children]. Cir Pediatr 2007; 20 (04) 194-198
• 3 Soong WJ, Tsao PC, Lee YS, Yang CF. Therapeutic flexible airway endoscopy of small children in a tertiary referral center-11 years' experience. PLoS One 2017; 12 (08) e0183078
• 4 Hatton MQ, Allen MB, Vathenen AS, Mellor E, Cooke NJ. Does sedation help in fibreoptic bronchoscopy?. BMJ 1994; 309 (6963): 1206-1207
• 5 Nussbaum E. Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children. Laryngoscope 1983; 93 (08) 1073-1075
• 6 Wood RE. Spelunking in the pediatric airways: explorations with the flexible fiberoptic bronchoscope. Pediatr Clin North Am 1984; 31 (04) 785-799
• 7 McCoy S, Lyttle MD, Hartshorn S, Larkin P, Brenner M, O'Sullivan R. ; PERUKI. A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland. Emerg Med J 2016; 33 (08) 527-532
• 8 Dang D, Robinson PC, Winnicki S, Jersmann HP. The safety of flexible fibre-optic bronchoscopy and proceduralist-administered sedation: a tertiary referral centre experience. Intern Med J 2012; 42 (03) 300-305
• 9 Godfrey S, Avital A, Maayan C, Rotschild M, Springer C. Yield from flexible bronchoscopy in children. Pediatr Pulmonol 1997; 23 (04) 261-269
• 10 Berkenbosch JW, Graff GR, Stark JM. Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy. Chest 2004; 125 (03) 1132-1137
• 11 Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med 2011; 57 (02) 109-114.e2
• 12 José RJ, Shaefi S, Navani N. Sedation for flexible bronchoscopy: current and emerging evidence. Eur Respir Rev 2013; 22 (128) 106-116
• 13 Krauss BS, Krauss BA, Green SM. Procedural sedation and analgesia in children. N Engl J Med 2014; 371 (01) 91
• 14 Szczeklik W, Andrychiewicz A, Górka K, Konarska K, Soja J, Sładek K. Flexible bronchoscopy under conscious sedation with midazolam and fentanyl can be safely performed by nonanesthesiologists. Pol Arch Med Wewn 2015; 125 (11) 869-871
• 15 Coté CJ, Wilson S. ; American Academy of Pediatrics; American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 2016; 138 (01) e20161212