Published online Nov 4, 2017. doi: 10.5492/wjccm.v6.i4.179
Peer-review started: February 12, 2017
First decision: May 17, 2017
Revised: June 30, 2017
Accepted: September 3, 2017
Article in press: September 4, 2017
Published online: November 4, 2017
Processing time: 268 Days and 23.8 Hours
To evaluate the safety and efficacy of sedating pediatric patients for outpatient flexible bronchoscopy.
A retrospective chart review was conducted for all children, age 17 years or under who underwent flexible bronchoscopy under deep sedation in an outpatient hospital-based setting. Two sedation regimens were used; propofol only or ketamine prior to propofol. Patients were divided into three age groups; infants (less than 12 mo), toddlers (1-3 years) and children (4-17 years). Demographics, indication for bronchoscopy, sedative dosing, sedation and recovery time and adverse events were reviewed.
Of the total 458 bronchoscopies performed, propofol only regimen was used in 337 (74%) while propofol and ketamine was used in 121 (26%). About 99% of the procedures were successfully completed. Children in the propofol + ketamine group tend to be younger and have lower weight compared to the propofol only group. Adverse events including transient hypoxemia and hypotension occurred in 8% and 24% respectively. Median procedure time was 10 min while the median discharge time was 35 min. There were no differences in the indication of the procedure, propofol dose, procedure or recovery time in either sedative regimen. When compared to other age groups, infants had a higher incidence of hypoxemia.
Children can be effectively sedated for outpatient flexible bronchoscopy with high rate of success. This procedure should be performed under vigilance of highly trained providers.
Core tip: In this retrospective study “Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy”, we are presenting our center data on pediatric patients who underwent flexible bronchoscopy under deep sedation using propofol. The study outlines our experience with intensivist-based procedural sedation as an effective strategy to facilitate successful completion of flexible bronchoscopy. This is the largest retrospective study describing the use of propofol-based procedural sedation in the outpatient settings for pediatric flexible bronchoscopy.