Flexible Bronchoscopy under Bronchoscopist ...

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lower airway anomalies including trachea-bronchomalacia in both BAMS and GA groups21. 10.7% of the BAMS children had FB due to abnormal radiological ...
Flexible Bronchoscopy under Bronchoscopist Administered Moderate Sedation vs. General Anesthesia: A Comparative Study in Children 1) Pritish Mondal, MD (Corresponding author) Assistant Professor, Pediatric Pulmonary Section; Penn State College of Medicine 500 University Drive, P.O. Box 850, Hershey, PA 17033 [email protected] 2) Priti Dalal, MD Associate Professor, Department of Anesthesia, Division Chief, Pediatric Anesthesia, Penn State College of Medicine 3) Niruja Sathiyadevan, MD Department of Anesthesia, Penn State College of Medicine, 4) Snyder, David M, Medical Student (1st year), Penn State College of Medicine 5) Satyanarayan Hegde, MD Assistant Professor, Pediatric Pulmonary Section; University of Chicago

Abstract: Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with midazolam/fentanyl combination or general anesthesia (GA). However, the outcome of BAMS has not been well established in children. Currently, most of the centers prefer FB under GA. Both techniques have their advantages and disadvantages with implications for safety, complication and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency and cost-effectiveness of FB under BAMS compared to FB under GA in a similar setup. Methods: We performed a retrospective chart review to compare BAMS vs. GA for FB in children. We recruited BAMS children (n=295) from University of Florida, and GA children (n=100) from Pennsylvania State University. Both the groups had similar indications, complexities, procedural environment. Comparison of various time-intervals including preprocedure time, sedation-induction time, scope time and post-procedure time among different BAMS vs. GA age-groups were the primary outcome. While the secondary outcomes were the determination of the rate of complications, the dosage of sedative/anesthetic, cost-effectiveness and sedation pattern under BAMS. Results: FB under BAMS required significantly higher pre-procedure time and sedationinduction time (p10-18 years

Table 1: Age-wise distribution of participants comparing weights between BAMS and GA subjects demonstrates no significant differences

3.1. Indication: Chronic cough was the most common indication for FB followed by upper and lower airway anomalies including trachea-bronchomalacia in both BAMS and GA groups21. 10.7% of the BAMS children had FB due to abnormal radiological findings, while 10.1% of GA children had FB as a part of infectious disease work up. The indications are demonstrated in figure 1.

Fig 1: Indications for Flexible Bronchoscopy (percentage) under BAMS compared to General Anesthesia. Chronic cough and anatomical airway anomalies were among the most common indications in both of the groups 3.2. Complication: All BAMS were completed with spontaneous recovery without requiring reversal of sedation, and without major complications or requirement for an overnight stay in the hospital. Broncho-alveolar lavage (BAL) was routinely routinely performed as a component of FB. Two infants had reported complications, with one having desaturation to 69%, and the other having transient stridor. Only three toddlers had reported complications: a one-year-old girl had bradycardia to 50s that resolved spontaneously, while another two-year-old girl had desaturation to high 80s requiring blow-by oxygen, and a one-year-old girl had stridor noted at the end of the procedure that resolved upon awakening. A four-year-old boy had mild stridor during FB, which responded to racemic epinephrine. Additionally, a three-year-old boy had transient desaturation

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