Flexible Bronchoscopy Under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia: A Comparative...

Area of Science:

• Pediatric Pulmonology
• Anesthesiology
• Medical Procedures

Background:

• Flexible bronchoscopy (FB) in children is often performed under general anesthesia (GA).
• Bronchoscopist-administered moderate sedation (BAMS) is an alternative, but its outcomes in pediatric patients require further evaluation.
• Current practices lean towards GA, necessitating a comparison of BAMS and GA for FB in children.

Purpose of the Study:

• To evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS compared to GA in pediatric patients.
• To compare procedural times, complication rates, and sedation patterns between BAMS and GA for pediatric FB.

Main Methods:

• A retrospective chart review comparing BAMS (n=295) and GA (n=100) for FB in children.
• Inclusion of patients from two children's hospitals with similar indications and procedural environments.
• Primary outcomes included preprocedure, sedation-induction, scope, and post-procedure times; secondary outcomes included complication rates, sedative dosages, and cost-effectiveness.

Main Results:

• FB under BAMS required longer preprocedure and sedation-induction times but shorter scope and post-procedure times compared to GA (P<0.001 for all).
• Younger children exhibited deeper sedation for extended periods under BAMS.
• The BAMS group demonstrated lower sedation service costs and complication rates than the GA group.

Conclusions:

• Flexible bronchoscopy under BAMS is feasible in children, offering advantages in cost and reduced complications compared to GA.
• The safety of BAMS in pediatric FB could not be definitively established in this retrospective study.
• BAMS may potentially compromise diagnostic yield due to the bronchoscopist's dual role in sedation management and airway monitoring.