Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy

Area of Science:

• Pediatric Anesthesiology
• Pulmonology
• Medical Safety

Background:

• Flexible bronchoscopy is a common procedure in pediatric care.
• Sedation is often required for pediatric flexible bronchoscopy.
• Optimizing sedation regimens is crucial for patient safety and procedure success.

Purpose of the Study:

• To assess the safety and efficacy of deep sedation for pediatric outpatients undergoing flexible bronchoscopy.
• To compare two sedation regimens: propofol alone versus ketamine followed by propofol.
• To analyze sedation outcomes across different pediatric age groups.

Main Methods:

• Retrospective chart review of 458 pediatric patients (≤17 years) undergoing outpatient flexible bronchoscopy.
• Analysis of two sedation regimens: propofol only (74%) and ketamine/propofol (26%).
• Stratification into age groups: infants (<12 mo), toddlers (1-3 yrs), and children (4-17 yrs).

Main Results:

• Procedure success rate was 99%.
• Adverse events included transient hypoxemia (8%) and hypotension (24%), with infants showing higher hypoxemia rates.
• Median procedure and discharge times were 10 and 35 minutes, respectively, with no significant differences between sedation groups.

Conclusions:

• Deep sedation is safe and effective for pediatric outpatient flexible bronchoscopy.
• High success rates are achievable with appropriate sedation strategies.
• Vigilance by highly trained providers is essential, particularly for infants.