An Investigation of the Pediatric Rigid Bronchoscopy Complication with three Different Anesthesia Regimes

Abstract

Background: Foreign body aspiration is common in children and poses a significant risk of morbidity and mortality. Rigid bronchoscopy is the most common method for removing aspirated foreign bodies. Objectives: Anesthesiologists play a critical role in managing these procedures, aiming to find the best strategies with the fewest complications. This study aims to compare anesthesia-related complications during rigid bronchoscopy in children using muscle relaxants versus no muscle relaxants. Methods: In this clinical trial, 60 eligible children were randomly divided into three equal groups: SP: Spontaneous ventilation with sevoflurane and propofol; VA: Controlled ventilation with sevoflurane and atracurium; VR: Controlled ventilation with sevoflurane and rocuronium. At the end of anesthesia, complications such as cough, bucking, hypoxemia, laryngospasm, and bronchospasm were compared, along with the pulmonologist’s level of satisfaction, surgery duration, and total anesthesia time in the three groups. Results: The comparison between the SP, VR, and VA groups revealed the following: No significant difference was found in the incidence of cough and respiratory distress following foreign body aspiration among the three groups (P = 0.262 and P = 0.762, respectively); minimum oxygen saturation during rigid bronchoscopy differed significantly between the groups (P = 0.013); bucking during bronchoscopy was significantly more frequent in the SP group (P = 0.017); laryngospasm was significantly more common in the SP group compared to the other two groups (P = 0.004); agitation during recovery was significantly lower in the propofol (SP) group; pulmonologist satisfaction was highest in the VR group, followed by the VA group, with a significant difference compared to the SP group (P = 0.021); although the SP group experienced more frequent hypoxemia, the difference was not statistically significant; there was no significant difference in anesthesia or bronchoscopy duration across the three groups. Conclusions: The study results suggest that using muscle relaxants in rigid bronchoscopy offers several advantages, including fewer intraoperative complications such as bucking and laryngospasm. Additionally, controlled ventilation reduced the need for intravenous anesthetics and opioids, minimizing adverse effects and shortening recovery times.