Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

Wang, Hanbing; Yang, Cheng-xiang; Zhang, Bin; Xia, Yun; Liu, Hongzhen; Liang, Hua

doi:10.11622/smedj.2013243

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…Bronchoscopy without sedation is a painful and uncomfortable experience. [ 17 ] TCI anesthesia with propofol and short-acting opioids is reported to provide satisfactory anesthesia for flexible bronchoscopy, when assisted with repeated topical anesthesia every 10 to 15 minutes. [ 18 ] However, cough, apnea, hypoxemia during procedure could not be fully avoided and thus disrupted the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] However, cough, apnea, hypoxemia during procedure could not be fully avoided and thus disrupted the procedure. [ 17 – 19 , 21 ] Previous study reported that anesthesia for flexible bronchoscopy required TCI via propofol Cp of 3 to 4 μg/ml. [ 17 ] It has also been demonstrated that effect-site C 50 concentration of propofol was 2.2 μg/ml when subjects had no response to verbal stimulation and shaking.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

Liao¹,

Hsieh³

et al. 2020

Medicine

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Introduction: Evolving techniques in the field of therapeutic bronchoscopy have led to the return of rigid bronchoscopy in the treatment of complex central airway disease. Rigid bronchoscopy is typically performed under general anesthesia because of the strong stimulation caused by metal instruments. Anesthesia for rigid bronchoscopy is challenging to administer because anesthesiologists and interventionists share the same working channel: the airway. Previously reviewed anesthetic methods are used primarily for short procedures. Balanced anesthesia with ultrasound-guided superior laryngeal nerve (SLN) block and total intravenous anesthesia might provide anesthesia for a prolonged procedure and facilitate patient recovery. Patient concerns: A patient with obstructed endobronchial stent was referred for therapeutic rigid bronchoscopy, which requires deeper anesthesia than flexible bronchoscopy. There were concerns of the stronger stimulation of the rigid bronchoscopy, lengthy duration of the procedure, higher risk of hypoxemia, and the difficulty of mechanical ventilation weaning after anesthesia due to the patients co-morbidities. Diagnosis: A 66-year-old female patient presented with a history of breast cancer with lung metastases. Right main bronchus obstruction due to external compression of lung metastases was relieved through insertion of an endobronchial stent, but obstructive granulation developed after 4 months. Presence of the malfunctioning stent caused severe cough and discomfort. Removal of the stent by using a flexible bronchoscope was attempted twice but failed. Interventions: Regional anesthesia of the upper airway through ultrasound-guided SLN block combined with intratracheal 2% lidocaine spray was performed to assist in total intravenous anesthesia (TIVA) during rigid bronchoscopy. Outcomes: The patient maintained steady spontaneous breathing throughout the procedure without laryngospasm, bucking, or desaturation. Emergence from anesthesia was smooth and rapid after propofol infusion was discontinued. The surgery lasted 2.5 hours without discontinuity, and no perioperative pulmonary or cardiovascular complications were noted. Conclusion: Ultrasound-guided SLN block is a simple technique with a high success rate and low complication rate. Application of SLN block to assist TIVA provides sufficient anesthesia for lengthened therapeutic rigid bronchoscopy without interruption and facilitates patient recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

Liao¹,

Hsieh³

et al. 2020

Medicine

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“…However, because of the narrow therapeutic index between moderate sedation and respiratory depression, propofol is now strongly recommended for use only by anesthesiologists with close monitoring. [27,28] Ketamine has been more and more used in the children's flexible bronchoscopy for its sympatholytic and analgesic effects as well as being a potent bronchodilator, but it has the deficiency of increasing salivation and secretions and cannot attenuate the upper airway reflexes. [29,30] Though opioids are frequently used during bronchoscopy for analgesic property, their sedative effect is weak to complete the procedure.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

Jin²,

Zhang³

et al. 2017

Medicine

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Flexible bronchoscopy is more and more used for diagnosis and management of various pulmonary diseases in pediatrics. As poor coordination of children, the procedure is usually performed under general anesthesia with spontaneous or controlled ventilation to increase children and bronchoscopists’ safety and comfort. Previous studies have reported that dexmedetomidine (DEX) could be safely and effectively used for flexible bronchoscopy in both adulate and children. However, there is no trial to evaluate the dose-finding of safety and efficacy of dexmedetomidine-remifentanil (DEX-RF) in children undergoing flexible bronchoscopy.The objective of this study is to evaluate the dose-finding of safety and efficacy of DEX-RF in children undergoing flexible bronchoscopy.One hundred thirty-five children undergoing flexible bronchoscopy with DEX-RF were divided into 3 groups: Group DR1 (n = 47, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 0.5 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1), Group DR2 (n = 43, DEX infusion at 1 μg kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 1 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1), Group DR3 (n = 45, DEX infusion at 1.5 μg kg–1 for 10 minutes, then adjusted to 0.5–0.7 μg kg–1 h–1; RF infusion at 1 μg kg–1 for 2 minutes, then adjusted to 0.05–0.2 μg kg–1 min–1). Ramsay sedation scale of the 3 groups was maintained 3. Anesthesia onset time, total number of intraoperative children movements, hemodynamics (heart rate, arterial pressure, pulse oxygen saturation (SpO2), respiratory rate), total cumulative dose of dexmedetomidine and remifentanil, the amount of midazolam and lidocaine, time to first dose of rescue midazolam and lidocaine, postoperative recovery time, adverse events, bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DR3 group (14.23 ± 5.45 vs 14.45 ± 5.12 vs 11.13 ± 4.51 minutes, respectively, of DR1, DR2, DR3, P = 0.003). Additionally, the perioperative hemodynamic profile was more stable in group DR3 than that in the other 2 groups. Total number of children movements during flexible bronchoscopy was higher in DR1 group than the other 2 groups (46.81% 22/47 vs 34.88% 15/43 vs 17.78% 8/45, respectively, of DR1, DR2, DR3, P = 0.012). Total doses of rescue midazolam and lidocaine were significantly higher in DR1 and DR2 groups than that of DR3 group (P = 0.000). The time to first dose of rescue midazolam and lidocaine was significantly longer in DR3 group than DR1 and DR2 groups (P = 0.000). Total cumulative dose of dexmedetomidine was more in DR2 and DR3 groups (P = 0.000), while the amount of remifentanil was more in DR1 and DR2 groups (P = 0.000). The time to recovery for discharge from the PACU was significantly shorter in DR1 group compared with the other 2 groups (P = 0.000). Results from bronchoscopist satisfaction score showed significantly higher in DR2 and DR3 groups than that of DR1 group (P = 0.02...

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“…However, its pharmacological effects vary among patients, and it may depress the ventilatory drive and finally cause apnea, especially in patients with co-morbidities who are taking other respiratory depressant drugs [20, 21]. As a short-acting anesthetic agent with rapid recovery, propofol has been widely used in many clinical fields such as gastrointestinal endoscopy, thyroplasty, bronchoscopy, interventional or radiological procedures, and during awake bronchoscopy intubation, for its hypnotic effect [22, 23]. Ketamine, on the other hand, has been increasingly used for flexible bronchoscopy in children for its sympatholytic and analgesic effects, as well as for its potent bronchodilator actions.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine plus sufentanil for pediatric flexible bronchoscopy: A retrospective clinical trial

Dang

Yang

et al. 2017

Oncotarget

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Several studies have reported the use of dexmedetomidine (DEX) plus opioids for flexible bronchoscopy in both adults and children. To determine whether DEX plus sufentanil (SF) is safe for children, 142 children undergoing flexible bronchoscopy were assigned to one of three groups, each of which received the same SF loading dose and similar DEX and SF maintenance doses, but different loading doses of DEX: DS1 (DEX 0.5 μg·kg–1), DS2 (DEX 1.0 μg·kg–1), and DS3 (DEX 1.5 μg·kg–1). The Ramsay sedation scale was maintained at 3 in all groups. Results showed that anesthesia onset time was shorter, and the perioperative hemodynamic profile was more stable, in the DS3 group. The number of intraoperative movements was also lowest in the DS3 group. The time to first dose of rescue midazolam and lidocaine was significantly longer, but the total corresponding accumulated doses were lower in the DS3 group. Although the time to recovery prior to discharge from the post anesthesia care unit was longer, the overall incidence of tachycardia was lower in the DS3 group, and it received the highest bronchoscopist satisfaction score among the three groups. We therefore conclude that high-dose DEX plus SF can be safely and efficaciously used in children undergoing flexible bronchoscopy.

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Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy

Cited by 8 publications

References 17 publications

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure

The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy

Dexmedetomidine plus sufentanil for pediatric flexible bronchoscopy: A retrospective clinical trial

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