Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

Bhat, Javeed I.; Charoo, Bashir Ahmad; Tramboo, Zubair Mushtaq; Zahoor, Shihab

doi:10.1055/s-0039-1692173

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…Consistent with the results of previous studies, hypoxia was one of the most common complications during FB in our study ( Bhat et al, 2019 ). Less frequent episodes of hypoxemia and severe hypoxemic events, as well as higher mean lowest SpO 2 values, have been shown when capnography is used, due to improved monitoring, especially in sedated patients receiving supplemental oxygen ( Parker et al, 2018 ).…”

Section: Discussionsupporting

confidence: 94%

“…Ketamine is a potent bronchodilator that can preserve airway patency and respiratory function, and has with sympathomimetic properties. However, ketamine may cause delirium, hallucinations, higher incidence of intense cough, and hypersalivation ( Bhat et al, 2019 ). In summary, the ideal sedatives should be characterized by rapid onset, short action, wide margin of safety, minimal residual sedation, and minimal side effects; in addition, they should be rapidly reversible.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Chen

Xin

et al. 2022

Front. Pharmacol.

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Purpose: This study aimed to compare the efficacy and safety of remimazolam tosilate-remifentanil (RT-RF) vs dexmedetomidine-remifentanil (Dex-RF) for outpatients undergoing fiberoptic bronchoscopy (FB).Patients and methods: We conducted a double-blind, randomized, prospective study involving a total of 146 outpatients undergoing FB divided into two groups. The RT-RF (RR) group (n = 73) received an initial dose of 12 mg/kg/h of RT for 10 min followed by a maintenance dose of 1–2 mg/kg/h, while the Dex-RF (DR) group (n = 73) received an initial dose of 0.5 μg/kg of Dex for 10 min followed by a maintenance dose of 0.2–0.7 μg/kg/h. All outpatients also received 0.05–0.2 μg/kg/min RF to maintain the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scale <3. The primary outcome was rate of successful FB completed. Secondary outcomes were time metrics, hemodynamics, intubating conditions, oxygen saturation, coughing severity, number of remedies, total dose of fentanyl, RF, RT, and Dex, incidence of dreaming, patient and bronchoscopist satisfaction, willingness to repeat bronchoscopy, and adverse events.Results: The FB successful completion rate was 94.52% (95% CI: 89.20–99.90) in the RR group and 91.78% (95% CI: 85.30–98.20) in the DR group. Compared with patients in the DR group, the onset time, time to fully alert, and hospital discharge were all significantly shorter in the RR group (p < 0.01), and hemodynamics were more stable in the RR group. Intubating conditions, clinically acceptable intubating conditions, lowest oxygen saturation, coughing severity, consumption of fentanyl and RF, number of remedies, and patient and bronchoscopist satisfaction were similar between the groups (p > 0.05), as were demographic characteristics, incidence of dreaming, willingness to repeat bronchoscopy, and adverse events (p > 0.05).Conclusion: RT-RF has non-inferior efficacy, better time metrics and hemodynamic stability for outpatients undergoing FB than Dex-RF.Systematic Review Registration: [http://www.chictr.org.cn/showproj.aspx?proj=66673], identifier [ChiCTR2000041524].

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Chen

Xin

et al. 2022

Front. Pharmacol.

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“…Usually, general anesthesia may be avoided to maintain spontaneous breathing, reduce side effects, and shorten hospitalization 1 . Procedural sedation using different combinations of sedatives with or without opioid use is safe in pediatric patients 2,3 . However, the quality of the examination and the frequency of complications during flexible bronchoscopy in children mainly depend on coughing frequency and sedation quality.…”

Section: Introductionmentioning

confidence: 99%

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Tschiedel

Eckerland

Felderhoff‐Mueser

et al. 2020

Pediatric Pulmonology

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Introduction In pediatric patients, flexible bronchoscopy requires deep sedation. Different sedation regimes are common, but only some of them include opioids. Due to their antitussive effect, the use of short‐acting opioids may be beneficial for this particular indication, but additional respiratory depression may lead to an increase in adverse events. Here, we systematically compared sedation regimes in children undergoing flexible bronchoscopy with either propofol alone, or a combination of propofol and remifentanil. The primary outcome parameter was the frequency of coughing episodes during the intervention. Secondary outcome parameters were frequency and types of complications, patient satisfaction, examiner satisfaction, and recovery time after finishing the sedation. Methods Fifty children aged 1–17 years undergoing flexible bronchoscopy under deep sedation with propofol were randomly assigned to two groups: PR receiving propofol and remifentanil and PP receiving propofol only. Sedation depth was predefined as Comfort Score 10–13. Results We found significantly less coughing episodes ([med (IQR)] PR: 0.73 (0.28–2.45)/min; PP: 1.98 (1.26–3.12)/min; p = .010) and shorter recovery time in Group PR (PR: 13.5 (8–17.5) min; PP: 21.0 (14–27) min; p = .011). Examiner's satisfaction was higher in Group PR (PR: 10 (8–10); PP: 9 (7–9); p = .012). The number of adverse events, patient satisfaction, and required propofol dose during the intervention did not differ between groups. Conclusion We suggest the combination of propofol with remifentanil instead of using propofol alone in pediatric procedural sedation for flexible bronchoscopy.

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“…Since most of the children cannot produce sputum, the collection of bronchoalveolar lavage fluid (BALF) for the microbiological analysis has been found very useful in the management of complicated pneumonia. Several studies have documented the diagnostic utility of BAL in patients with complicated pneumonia, including patients with ventilator-associated pneumonia (VAP), non-resolving consolidation, pneumonia in immunocompromised and cystic fibrosis 6–8. BAL analysis is seldom diagnostic by itself in childhood interstitial lung diseases (ILDs), but BAL cell pattern results may support the diagnosis and/or narrow the differential diagnosis when considered in the context of the medical history, physical examination and radiological findings 5.…”

Section: Introductionmentioning

confidence: 99%

“…Bronchoscopic BAL is safe procedure as well with very little complication rate and can be done safely under conscious sedation 6. The present study was conducted with the aim to study the role of bronchoscopic BALF analysis in various paediatric respiratory diseases especially in context of resource-constrained settings.…”

Section: Introductionmentioning

confidence: 99%

Enhancing respiratory disease diagnosis by bronchoalveolar lavage in Kashmir: an audit of findings

et al. 2022

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ObjectiveTo study bronchoalveolar lavage (BAL) findings in various respiratory diseases in children in Kashmir India.DesignProspective observational study.SettingPaediatric department of the tertiary care hospital.PatientsChildren of both genders from 1 month to 17 years of ageInterventionAll studied patients underwent flexible bronchoscopy and BAL.Outcome measureTo observe the BAL findings in various respiratory diseases in the studied population.ResultsA total of 283 patients underwent BAL procedure. The positive BAL report was received in 131 (46%) patients. Out of these, 55 (42%) patients had positive BAL culture/ microscopy for different bacterial (50) and fungal species (Candida spp (3), Mucormycosis (1) and Aspergillus (1)). MTB was isolated in 25 (19%) patients. Twenty-three (17.5%) patients had bronchoalveolar lavage fluid (BALF) positive for pulmonary hydatidosis. Foamy macrophages were seen in 13 patients, significant eosinophilia in nine patients and hemosiderin-laden macrophages were seen in three patients.ConclusionWe found BALF a very useful sample for the evaluation of many infective and non-infective respiratory diseases in our region, which otherwise lacks high end diagnostics. 46% of our patients had some abnormalities in the BAL specimen. It provided us with valuable information regarding organism profile and drug sensitivity in case of lung infection. BALF analysis was also found useful in the diagnosis of some non-infective pulmonary disorders like acute eosinophilic pneumonia, aspiration syndromes and bronchial asthma.

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Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

Cited by 6 publications

References 16 publications

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Sedation for bronchoscopy in children: A prospective randomized double‐blinded trial

Enhancing respiratory disease diagnosis by bronchoalveolar lavage in Kashmir: an audit of findings

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