• Paediatric anaesthesia · Nov 2004

    Clinical Trial

    Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation.

    • John W Berkenbosch, Gavin R Graff, James M Stark, Zarah Ner, and Joseph D Tobias.
    • Department of Child Health, The University of Missouri-Columbia, Columbia, MO 65212, USA. berkenboschj@health.missouri.edu
    • Paediatr Anaesth. 2004 Nov 1;14(11):941-6.

    BackgroundFlexible fiberoptic bronchoscopy is an important diagnostic tool for pediatric pulmonologists. Because of its favorable respiratory profile, ketamine has become a popular sedative for this procedure, but may be associated with unpleasant emergence reactions in the older child. Remifentanil is a newer, ultra-short acting opioid that has been shown to provide effective sedation and cough suppression for fiberoptic bronchoscopy when combined with intermittent propofol boluses. However, delivery of these agents as a combined, single infusion has not been described.MethodsChildren > or =2 years of age undergoing fiberoptic bronchoscopy were enrolled. Remifentanil was mixed in a single syringe with undiluted propofol giving final drug concentrations of 10 mg x ml(-1) of propofol and 15-20 microg x ml(-1) of remifentanil. Sedation was induced with a bolus of approximately 0.1 ml x kg(-1) of this mixture and maintained by titrating the drip throughout the procedure. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.ResultsFifteen patients aged 9.0 +/- 5.3 years were sedated. Sedation was induced with 1.2 +/- 0.4 mg x kg(-1) propofol (2.4 +/- 0.8 microg x kg(-1) remifentanil) and maintained with 4.1 +/- 1.8 mg x kg(-1) x h(-1) propofol (0.13 +/- 0.06 microg x kg(-1) x min(-1) remifentanil). Five patients received low-dose ketamine to augment sedation. The maximal decrease in respiratory rate was 6.1 +/- 5.3 b x min(-1) (27.6 +/- 21%) and no patient became hypoxemic. All procedures were completed easily without significant complication. Patients recovered to baseline 13.3 +/- 8.5 min following infusion discontinuation.ConclusionsA remifentanil/propofol mixture provided effective sedation and rapid recovery in pediatric patients undergoing fiberoptic bronchoscopy.

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