Amnestic agents in pediatric bronchoscopy

Study objective: To assess the risk for complications with the use of sedat ion and analgesia techniques in pediatric fiberoptic bronchoscopy. Design: A retrospective case series, Setting: The ICU of a 325-bed tertiary care research hospital. Patients: Patients from 1 to 18 years of age who underwent fiberoptic bronc hoscopy with BAL or transbronchial biopsy between June 1991 and December 19 95 and received IV sedation and analgesia. Interventions: None. Methods: A retrospective chart review was performed. Extracted data include d anesthetics and sedatives used and their pel kilogram dosages, procedure durations, and complications including oxygen desaturations < 90%, vital si gn alterations that required intervention, and emergence reactions to ketam ine, Results: A total of 103 bronchoscopies were performed on 64 patients, Ketam ine was used as die primary anesthetic in GO procedures (58%). A combinatio n of fentanyl and midazolam nas used in 38 of the 43 remaining procedures, A variety of combinations were used in the five remaining procedures, Compl ications occurred in 13 procedures and included oxygen desaturations, strid or, cough, apnea, and nasal bleeding, Twelve of the 13 complications occurr ed in patients with a diagnosis of HIV infection, Eight of the 13 complicat ions involved children less than or equal to 3 years of age. Conclusions: Pediatric bronchoscopy is a safe and valuable procedure. Howev er, in this study, anesthetic selection was shown to adversely affect the c omplication rate in the subsets of children less than or equal to 3 cars of age and with an underlying diagnosis of HIV infection.