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BronchoscopySafety and Efficacy of Ketamine Sedation for Infant Flexible Fiberoptic Bronchoscopy
Section snippets
Bronchoscopy
This retrospective study was approved by the Institutional Review Board of the University of Missouri Health Sciences Center. All infants (< 1 year of age) who received ketamine during sedation for flexible fiberoptic bronchoscopy between June 1999 and December 2002 were reviewed. Patients in whom bronchoscopic evaluation occurred during endotracheal intubation and/or mechanical ventilation were excluded. All bronchoscopies were performed in the pediatric ICU by a pediatric pulmonologist with
Results
Fifty-nine sedations were performed on 55 patients during the study period. Patient characteristics are summarized in Table 1. Indications for bronchoscopy included chronic wheeze (n = 27), stridor (n = 22), cystic fibrosis microbiological surveillance (n = 9), chronic cough (n = 7), hemoptysis (n = 1), recurrent pneumonia (n = 1), and unexplained hypoxemia (n = 1). In some patients, multiple indications were present so the total number of indications exceeds the total number of procedures.
In
Discussion
The value of flexible fiberoptic bronchoscopy in the pediatric patient is well recognized,1234 particularly in the younger patient where the common indications for bronchoscopy (eg, “noisy breathing,” chronic wheeze) are more likely to be associated with abnormal findings.234 While most authors1234567 acknowledge the need for appropriate sedation during bronchoscopy in this population, few data exist regarding the effectiveness and safety of specific sedative agents or sedation regimens,
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2021, American Journal of Emergency MedicineCitation Excerpt :This likely would have made intubation more challenging, especially in the setting of severe bleeding [12]. Ketamine was used due to familiarity with the drug and its relative safety profile. [6,13,14]. There was no premedication for secretions, though preparations were made to manage them with glycopyrrolate and bedside equipment [13,14].
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2020, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :A few studies have compared combinations of anesthetic agents and their effects on the upper airway. Berkenbosch et al. [57] reported on 55 infants undergoing flexible fiberoptic bronchoscopy with ketamine/midazolam with or without fentanyl and showed that infants tolerated this regimen well but with mild hypoxemia in 9 of 59 procedures (15%) [57]. In a different study, Berkenbosch et al. [58] reported that propofol/remifentanil can be used safely in children undergoing flexible fiberoptic bronchoscopy without causing hypoxemia but 5 of 15 (33%) required low-dose ketamine boluses to augment sedation.
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2019, Anesthesiology ClinicsCitation Excerpt :Higher doses of ketamine directly reduce cardiac contractility and can precipitate cardiovascular collapse especially in those with catecholamine depletion.2,5,18,19 Ketamine preserves respiratory drive, but increases respiratory secretions.20,21 Ketamine may increase intracranial pressure (ICP), and its administration in patients with elevated ICP is controversial.2,22,23
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2008, Emergency Medicine Clinics of North AmericaCitation Excerpt :It has previously been thought that young age (eg, <6 months) was a contraindication to the use of ketamine. However, a recent study indicates that ketamine is safe and effective even in neonates.43 Ketamine is probably the sedative of choice for asthmatic patients for many reasons.
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