Premium
Use of a remifentanil–propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation
Author(s) -
Berkenbosch John W.,
Graff Gavin R.,
Stark James M.,
Ner Zarah,
Tobias Joseph D.
Publication year - 2004
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2004.01355.x
Subject(s) - remifentanil , medicine , propofol , sedation , anesthesia , sedative , ketamine , bronchoscopy , bolus (digestion) , surgery
Summary Background : Flexible 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. Methods : Children ≥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·ml −1 of propofol and 15–20 μ g·ml −1 of remifentanil. Sedation was induced with a bolus of approximately 0.1 ml·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. Results : Fifteen patients aged 9.0 ± 5.3 years were sedated. Sedation was induced with 1.2 ± 0.4 mg·kg −1 propofol (2.4 ± 0.8 μ g·kg −1 remifentanil) and maintained with 4.1 ± 1.8 mg·kg −1 ·h −1 propofol (0.13 ± 0.06 μ g·kg −1 ·min −1 remifentanil). Five patients received low‐dose ketamine to augment sedation. The maximal decrease in respiratory rate was 6.1 ± 5.3 b·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. Conclusions : A remifentanil/propofol mixture provided effective sedation and rapid recovery in pediatric patients undergoing fiberoptic bronchoscopy.