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[Bronchial endoscopy under local anesthesia and pain in children. The value of a nitrous oxide-oxygen combination]
Insights
Continuous nitrous oxide inhalation in children undergoing flexible fiberoptic bronchoscopy significantly reduced pain scores. This method, combined with standard anesthesia, offers a better procedural choice for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Pain Management
Background:
- Flexible fiberoptic bronchoscopy is a common pediatric procedure.
- Pain and discomfort during bronchoscopy can complicate the procedure and recovery.
- Effective pain management strategies are crucial for pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of continuous 50% nitrous oxide in oxygen for pain reduction during pediatric flexible fiberoptic bronchoscopy.
- To compare pain scores and physician satisfaction between nitrous oxide and oxygen administration.
Main Methods:
- 32 children (3-60 months) were randomized into two groups.
- Both groups received midazolam, atropine, and topical lidocaine.
- The experimental group received 50% nitrous oxide in oxygen; the control group received oxygen only.
- Pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).
- Physician satisfaction was measured using a visual analogue scale (VAS).
Main Results:
- Children receiving nitrous oxide exhibited significantly lower pain scores compared to the oxygen-only group.
- Physicians reported significantly higher satisfaction with procedures using nitrous oxide.
- No complications were observed in either group during the study.
Conclusions:
- Continuous administration of 50% nitrous oxide in oxygen is an effective method for reducing pain during pediatric flexible fiberoptic bronchoscopy.
- This approach, when combined with local anesthesia and sedation, represents an improved option for the procedure.
- Routine use of nitrous oxide in this context is recommended for enhanced patient comfort and procedural success.
Abstract:
To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.