Sedation with propofol for flexible bronchoscopy in children

Authors

  • Rashed A. Hasan MD, FAAP,

    Corresponding author
    1. St. Vincent Mercy Children's Hospital, Toledo, Ohio
    • 2213 Cherry Street, Toledo, OH 43612.
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    • Associate Clinical Professor of Pediatrics (University of Toledo Medical School), Attending Physician (St. Vincent Mercy Children's Hospital, Toledo, Ohio).

  • Ramalinga Reddy MD

    1. St. Vincent Mercy Children's Hospital, Toledo, Ohio
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    • Clinical Professor of Pediatrics (University of Toledo Medical School), Director, Pediatric Pulmonology (St. Vincent Mercy Children's Hospital, Toledo, Ohio).


Abstract

Background

The purpose of this study was to report our experience with intravenous propofol (IVP) sedation for flexible bronchoscopy (FB) in children.

Methods

The following data were collected: demographics, pre- and post-procedure diagnoses, induction time (IT), sedation time (ST), procedure time (PT), time to discharge from the hospital (TTD), induction dose (ID) of IVP, total dose (TD) of IVP, and complications. HR, RR, systolic BP (SBP), diastolic BP (DBP), and SpO2 were recorded every 5 min.

Results

One hundred three (66 males, 37 females) consecutive patients (age: 4.7 ± 4.3 years) and (weight: 21.2 ± 16 kg) were enrolled over a 3-year-period. Airway Abnormalities were diagnosed in 93 (90%) patients leading to a change in therapy in 68 (66%) patients. In 20 (19.4%) patients abnormalities unrelated to the primary indication for FB were found. IT was 4.64 ± 2 min, PT was 6.2 ± 3.1 min, ST was 27 ± 14 min, and TTD was 80 ± 44 min.

The ID and TD for IVP were 2.8 ± 0.1 mg/kg, and 3.1 ± 0.1 mg/kg respectively. Patients 4–7 years of age required higher induction doses (IDs) of propofol (3.5 ± 1 mg/kg) compared to infants (2.8 ± 0.9 mg/kg), 1–3 years of age (2.7 ± 0.78 mg/kg) and 8–17 years of age (2.4 ± 0.7 mg/kg) (P < 0.001). There was a correlation between the TD of IVP and TTD from the hospital (r = 0.5, P < 0.01). The drop in SBP (104 ± 15 vs. 92 ± 13 mm Hg, P < 0.05) and DBP (57 ± 13 vs. 46 ± 9 mm Hg, P < 0.05) during IVP were statistically significant compared to baseline, however none of the patients met the criteria for hypotension. Two patients developed short (<20 sec) respiratory pauses without hypoxia. No patient required fluid resuscitation or endotracheal intubation.

Conclusions

FB may be performed successfully in children using IVP and is associated with insignificant cardio-respiratory complications. Pediatr Pulmonol. 2009; 44:373–378. © 2009 Wiley-Liss, Inc.

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