Sedation for bronchoscopy in children: a prospective randomized double-blinded trial

Abstract

In pediatric patients, flexible bronchoscopy requires deep sedation. Different sedation regimes are common, but only some of them include opioids. Due to their antitussive effect, the use of short acting opioids may be beneficial for this particular indication, but additional respiratory depression may lead to an increase of adverse events. Here, we systematically compared coughing frequency (primary outcome parameter), frequency of adverse events, examiner and patient satisfaction, and recovery time (secondary outcome parameter) in children undergoing flexible bronchoscopy under sedation with either propofol alone, or a combination of propofol and remifentanil. Fifty children aged 1-17 years undergoing flexible bronchoscopy under deep sedation with propofol were randomly assigned to two groups: (PR) receiving propofol and remifentanil and (PP) receiving propofol only. Sedation depth was defined as Comfort Score 10-13. Results We found significantly less coughing episodes (PR: med 0.73 (IQR 0.28-2.45)/min; PP: med 1.98 (IQR 1.26-3.12)/min; p=0.010) and shorter recovery time in group PR (PR: med 13.5 (IQR 8-17.5) min; PP: med 21.0 (IQR 14-27) min; p=0.011). Examiner’s satisfaction was higher in group PR (PR: med 10 (IQR 8-10); PP: med 9 (IQR 7-9); p=0.012). The number of adverse events, patient satisfaction, and required propofol dose during the intervention did not differ between groups. Therefore, we suggest the combination of propofol with remifentanil instead of using propofol alone in pediatric procedural sedation for flexible bronchoscopy.