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

Tschiedel, Eva; Eckerland, Maximilian; Felderhoff‐Mueser, Ursula; Dohna-Schwake, Christian; Stehling, Florian

doi:10.1002/ppul.25235

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…The results suggest that a relatively high dose of remifentanil was used in the cough suppression group, and there was a significant difference in extubation response. This suggests that remifentanil can effectively inhibit the cough response, which is consistent with the results of a previous study ( Tschiedel et al, 2021 ). Although the times for extubation and the time for awakening were slightly longer in the cough suppression group than in the cough group, the differences between the two groups were not statistically significant.…”

Section: Discussionsupporting

confidence: 92%

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

et al. 2022

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Objective: This study aimed to determine the effective dose 50% (ED50) value of remifentanil in inhibiting coughing during extubation in children with snoring.Methods: The subjects were children who scored a grade I in the American Society of Anesthesiology (ASA) metric and who were undergoing tonsillectomy (with or without adenoidectomy) under general anesthesia. Using Dixon’s up-and-down sequential method, the initial infusion rate of remifentanil was 0.06 μg/kg/min, and the difference between the infusion rates of the two adjacent groups was 0.01 μg/kg/min. If a child had no cough response during extubation, the infusion rate for the next child was reduced by 0.01 μg/kg/min. If that child had cough response, the infusion rate for the next child was increased by 0.01 μg/kg/min, and the test was terminated when seven pairs of children with positive-negative alternating results were obtained. The ED50 value and its 95% confidence interval (CI) were calculated by probit regression. The times for extubation, awakening, agitation, and respiratory complications after extubation were compared between the two groups.Results: 1) The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation was 0.042 μg/kg/min, and the 95% confidence interval was 0.025–0.062 μg/kg/min. 2) The total dosage and infusion rate of remifentanil in the cough suppression group were higher than those in the cough group (p < 0.05), but the differences in the times for extubating and awakening between the two groups were not statistically significant (p > 0.05). 3) There was no correlation between the infusion rate of remifentanil and the time for extubating and awakening in the cough suppression group; the r values were 0.13 and 0.12, respectively, and p > 0.05. 4) The differences in postoperative respiratory complications between the two groups were not statistically significant (p > 0.05).Conclusion: The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation after tonsillectomy (with or without adenoidectomy) was 0.042 μg/kg/min, and a low-dose infusion of remifentanil does not affect the times for awakening and extubating in children.

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Section: Discussionsupporting

confidence: 92%

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

et al. 2022

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“…The control of coughing by opioids may be outweighing the risk for hypoventilation and apnea ( Tschiedel et al, 2021 ). Because of the disadvantages of fentanyl in terms of offset time, hepatic metabolism, and accumulation and prolonged effect with continuous infusion, we chose RF as the preferred opioid in this study ( Lin et al, 2019 ).…”

Section: Discussionmentioning

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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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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“…Propofol se daje za sedaciju kao indukcioni bolus 1 mg/kg tokom 30 sekundi, a onda kao dodatni bolus 1-2 mg/kg na 3-5 minuta ili kontinuirano 6-10 mg/kg/h. Neželjeni efekti su iritacija vene, bradikardija, hipotenzija, respiratorna depresija, pruritus, a u slučaju intoksikacije, nastaju aritmije, srčani zastoj, depresija CNS-a i apneja 12,18,19 . S-Ketamin.…”

Section: Vrste Lekova Koje Se Koriste Tokom Fbunclassified

Analgosedation and anaesthesia for flexible bronchoscopy in children

Stevanović,

Krunić,

Ilić

et al. 2023

Serb J Anest Inten Therapy

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Flexible bronchoscopy become the gold standard in pediatric pulmonology for evaluating airways and lung diseases. This invasive procedure has diagnostic and therapeutic significance. Children, following their age, have anatomical, physiological and psychological differences, which determine the necessity of performing flexible bronchoscopy under analgosedation or general anaesthesia. Careful preoperative preparation and a conversation with the parents, the child and the bronchoscopist are crucial for the creation of a safe anaesthesia plan and minimizing the possibility of complications.

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

Cited by 10 publications

References 28 publications

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

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

Analgosedation and anaesthesia for flexible bronchoscopy in children

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