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Abstract

Introduction: Pediatric flexible bronchoscopy has become increasingly important in the evaluation of pulmonary abnormalities in children. Sedating such patients has become standard care with the hope of improving the success and tolerance of these procedures. Our intensivist-based procedural sedation team has assisted pulmonologists to sedate children with flexible bronchoscopy. We hypothesized that our team delivers care which safely and effectively facilitates the successful completion of this procedure. Methods: Retrospective chart review of all sedations performed from 2007 to 2011 for flexible bronchoscopy. These procedures occurred in an outpatient hospital-based setting. Procedural sedations consist of either a propofol only approach or one using ketamine premedication(0.5mg/kg for < 20 kg patients or 0.25mg/kg for patients > 20kg) followed by propofol. Demographics, sedative dosing, sedation and recovery time, interventions and adverse events were reviewed. Results: 508 procedures were performed. Average patient age was 6.07 y (range 0.17-16.98y). 99% of the procedures were successfully completed. Four cases (two toddlers and two adolescents) were stopped early due to recalcitrant hypoxemia where two patients were admitted to the pediatric intensive care unit. One of the four patients required intubation and two fluid boluses. Mild transient hypoxemia and hypotension occurred in 8% and 24% of the patients. Most patients (92%) received O2 via NC and few (4%) required brief BMV. Average procedure time was 11 min and the average time to discharge was 37 min. Propofol alone was used in 396 (78%) and 112 (22%) had ketamine pre-treatment. There were no differences in propofol dose (4.3 and 4.1 mg/kg respectively), complications or recovery time based on sedative regimen. Conclusions: Children can be safely sedated for flexible fiberoptic bronchoscopy via an intensivist-run sedation team in an exam room setting with expediency and a high rate of success. Under the vigilance of a highly trained group practice in pediatric respiratory and cardiovascular monitoring and management, there were few unanticipated sequel. There may be economic and workflo advantages to this appropoach.