Department of Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Pediatr Pulmonol. 2021 May;56(5):1221-1229. doi: 10.1002/ppul.25235. Epub 2020 Dec 29.
In pediatric patients, flexible bronchoscopy requires deep sedation. Different sedation regimes are common, but only some of them include opioids. Due to their antitussive effect, the use of short-acting opioids may be beneficial for this particular indication, but additional respiratory depression may lead to an increase in adverse events. Here, we systematically compared sedation regimes in children undergoing flexible bronchoscopy with either propofol alone, or a combination of propofol and remifentanil. The primary outcome parameter was the frequency of coughing episodes during the intervention. Secondary outcome parameters were frequency and types of complications, patient satisfaction, examiner satisfaction, and recovery time after finishing the sedation.
Fifty children aged 1-17 years undergoing flexible bronchoscopy under deep sedation with propofol were randomly assigned to two groups: PR receiving propofol and remifentanil and PP receiving propofol only. Sedation depth was predefined as Comfort Score 10-13.
We found significantly less coughing episodes ([med (IQR)] PR: 0.73 (0.28-2.45)/min; PP: 1.98 (1.26-3.12)/min; p = .010) and shorter recovery time in Group PR (PR: 13.5 (8-17.5) min; PP: 21.0 (14-27) min; p = .011). Examiner's satisfaction was higher in Group PR (PR: 10 (8-10); PP: 9 (7-9); p = .012). The number of adverse events, patient satisfaction, and required propofol dose during the intervention did not differ between groups.
We suggest the combination of propofol with remifentanil instead of using propofol alone in pediatric procedural sedation for flexible bronchoscopy.
在儿科患者中，软性支气管镜检查需要深度镇静。不同的镇静方案很常见，但其中只有一些包括阿片类药物。由于其镇咳作用，使用短效阿片类药物可能对这种特殊适应症有益，但额外的呼吸抑制可能会导致不良事件增加。在这里，我们系统地比较了在接受软性支气管镜检查的儿童中使用单独的丙泊酚或丙泊酚和瑞芬太尼联合的镇静方案。主要结局参数是干预期间咳嗽发作的频率。次要结局参数是并发症的频率和类型、患者满意度、检查者满意度以及镇静结束后的恢复时间。
50 名年龄在 1-17 岁的儿童在深度镇静下接受软性支气管镜检查，镇静药物为丙泊酚，随机分为两组：PR 组接受丙泊酚和瑞芬太尼，PP 组接受单纯丙泊酚。镇静深度预设为舒适度评分 10-13。
我们发现 PR 组咳嗽发作次数明显减少（[中位数（IQR）] PR：0.73（0.28-2.45）/min；PP：1.98（1.26-3.12）/min；p=0.010），PR 组的恢复时间更短（PR：13.5（8-17.5）min；PP：21.0（14-27）min；p=0.011）。PR 组检查者满意度更高（PR：10（8-10）；PP：9（7-9）；p=0.012）。两组之间不良事件的数量、患者满意度和干预期间所需的丙泊酚剂量无差异。
我们建议在儿科程序性镇静中，在进行软性支气管镜检查时，将丙泊酚与瑞芬太尼联合使用，而不是单独使用丙泊酚。
