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Vocal cord function and bispectral index in pediatric bronchoscopy patients emerging from propofol anesthesia
Author(s) -
Schroeck Hedwig,
Fecho Karamarie,
Abode Kathleen,
Bailey Ann
Publication year - 2010
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21207
Subject(s) - medicine , cord , propofol , anesthesia , stridor , vocal cord dysfunction , bronchoscopy , bispectral index , airway , surgery , asthma
Objective In children undergoing bronchoscopy for evaluation of stridor or respiratory symptoms, movement of the vocal cords is routinely assessed at the conclusion of flexible bronchoscopy with children still anesthetized. The effect of anesthesia on vocal cord function is not well described. This study aimed to characterize the relationship between depth of propofol anesthesia, as measured by Bispectral Index (BIS), and vocal cord movement in pediatric patients. Methods Children between 6 months and 12 years of age presenting for diagnostic flexible bronchoscopy were enrolled in this prospective observational study. Anesthesia was maintained with a propofol infusion which was discontinued upon completion of the lower airway evaluation. An independent observer recorded the BIS score every 15 sec from discontinuation of propofol whereas the pulmonologist continued to observe vocal cord motion. BIS scores were also recorded for each observed clinical endpoint (paradoxical and normal vocal cord movement, complete vocal cord closure, and volitional movement). Results Data were analyzed for 47 subjects. The BIS values increased significantly from the conclusion of the lower airway evaluation with return of normal vocal cord movement, complete vocal cord closure, and volitional movement ( P < 0.0005). BIS readings were higher for patients younger than 2 years. Paradoxical vocal cord movement was documented in 10.6% of subjects, but resolved in all subjects. Conclusions Our findings suggest that return of vocal cord function during emergence from propofol anesthesia is related to decreasing anesthetic depth with complete vocal cord closure occurring at BIS values near those associated with volitional movement. Pediatr Pulmonol. 2010; 45:494–499. © 2010 Wiley‐Liss, Inc.