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Use of midazolam ('Dormicum') and flumazenil ('Anexate') in paediatric bronchology
G Baktai1, E Székely, T Márialigeti
1Pediatric Institute Szabadsághegy, Budapest, Hungary.
Insights
Midazolam narcosis with flumazenil reversal is effective for pediatric bronchoscopy in children with chronic lung disease. Using fentanyl for analgesia proved most satisfactory, leading to prompt awakening and good expectoration.
Area of Science:
- Pediatric Pulmonology
- Anesthesiology
- Respiratory Medicine
Background:
- Chronic non-specific lung disease affects children, necessitating diagnostic procedures like bronchoscopy.
- Effective sedation and analgesia are crucial for pediatric bronchoscopy to ensure patient comfort and procedural success.
Purpose of the Study:
- To evaluate the efficacy and safety of midazolam narcosis with flumazenil reversal for pediatric bronchoscopy.
- To compare analgesia methods (nitrous oxide vs. fentanyl) during the procedure.
Main Methods:
- 107 bronchological examinations were performed on 100 children with chronic lung disease.
- Patients received midazolam for sedation, atropine premedication, and either nitrous oxide or fentanyl for analgesia.
- Flumazenil was administered post-procedure to reverse midazolam's effects.
Main Results:
- Midazolam provided effective sedation and comfortable sleep, with a mean examination time of 12 minutes 50 seconds.
- The fentanyl analgesia group showed more satisfactory results compared to the nitrous oxide group.
- Patients awakened promptly (1 minute) after flumazenil administration, with effective expectoration observed.
Conclusions:
- Midazolam narcosis combined with flumazenil reversal is a safe and effective method for pediatric bronchoscopy.
- Fentanyl is recommended over nitrous oxide for analgesia in this procedure.
- While effective, the procedure is not recommended for out-patients due to the need for muscle relaxation.
Abstract:
One hundred and seven bronchological examinations using midazolam narcosis in association with flumazenil were carried out in 100 children (mean age 3.5 years, range 4 months to 14 years) suffering from chronic non-specific lung disease. Rigid bronchoscopy was followed in 49 cases by bronchography. All patients were premedicated with atropine followed by midazolam (0.2 mg/kg intravenously). Ventilation was carried out with nitrous oxide and oxygen in 47 children and with oxygen only in 60 patients. After 3 mins, suxamethonium (2 mg/kg intravenously) was given for muscle relaxation and intubation carried out. Fifty-one of the children ventilated with oxygen only also received fentanyl (0.002 mg/kg intramuscularly), at the same time as atropine, to provide analgesia. After extubation, all patients were given flumazenil (0.1 to 0.2 mg intravenously) to reverse the effects of midazolam. The results showed that midazolam provided effective sedation and comfortable sleep (mean examination time 12 min 50 sec) and it was considered that the method using fentanyl rather than nitrous oxide for analgesia was the most satisfactory one. Patients awakened promptly (1 min) after flumazenil and quick and effective expectoration was noted, particularly important in those who had undergone bronchography. No complications were observed. Since this investigation, a further 500 bronchoscopics have been carried out using this method with the same results. Even though no narcosis equipment is required, it is recommended that, as with other procedures involving narcosis with muscle relaxation, bronchoscopy with these drugs should not be used in out-patients.