Flexible Bronchoscopy under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia

A Comparative Study in Children

Pritish Mondal, Priti Dalal, Niruja Sathiyadevan, David M. Snyder, Satyanarayan Hegde

Research output: Contribution to journalArticle

Abstract

Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with a 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, complications, and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS as compared with FB under GA in a similar setting. Methods: We performed a retrospective chart review to compare BAMS versus GA for FB in children. We recruited BAMS children (n = 295) from University of Florida (UF) Health Shands Children's Hospital, and GA children (n = 100) from Penn State Children's Hospital (PSHCH). Both the groups had similar indications, complexities, and procedural environments. Comparisons of various time-intervals including preprocedure time, sedation-induction time, scope time, and post-procedure time among different BAMS versus GA age-groups were the primary outcomes. The secondary outcomes were the determination of the rates of complications, the dosages of sedative/anesthetic, cost-effectiveness, and sedation patterns under BAMS. Results: FB under BAMS required significantly higher preprocedure times and sedation-induction times (P < 0.001∗∗ and P < 0.001∗∗ respectively) but shorter scope and post-procedure times compared with the GA group times (P < 0.001∗∗ and P < 0.001∗∗ respectively). Younger children had a deeper level of sedation for an extended period under BAMS. The costs for the sedation services and the complication rates were lower in the BAMS group compared with the GA group. Conclusion: Our study demonstrated the feasibility of BAMS in children. FB under BAMS had an advantage of lower cost and fewer procedural complications compared with FB under GA. Despite that, the safety of BAMS could not be conclusively established from this retrospective study. Moreover, BAMS can potentially compromise the diagnostic yield because the bronchoscopist is also responsible for monitoring sedation and managing the airway.

Original languageEnglish (US)
Pages (from-to)166-173
Number of pages8
JournalPediatric, Allergy, Immunology, and Pulmonology
Volume31
Issue number3
DOIs
StatePublished - Sep 1 2018

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Conscious Sedation
Bronchoscopy
General Anesthesia
Safety
Cost-Benefit Analysis
Deep Sedation
Costs and Cost Analysis
State Hospitals
Midazolam
Feasibility Studies
Fentanyl
Hypnotics and Sedatives

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

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title = "Flexible Bronchoscopy under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia: A Comparative Study in Children",
abstract = "Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with a 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, complications, and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS as compared with FB under GA in a similar setting. Methods: We performed a retrospective chart review to compare BAMS versus GA for FB in children. We recruited BAMS children (n = 295) from University of Florida (UF) Health Shands Children's Hospital, and GA children (n = 100) from Penn State Children's Hospital (PSHCH). Both the groups had similar indications, complexities, and procedural environments. Comparisons of various time-intervals including preprocedure time, sedation-induction time, scope time, and post-procedure time among different BAMS versus GA age-groups were the primary outcomes. The secondary outcomes were the determination of the rates of complications, the dosages of sedative/anesthetic, cost-effectiveness, and sedation patterns under BAMS. Results: FB under BAMS required significantly higher preprocedure times and sedation-induction times (P < 0.001∗∗ and P < 0.001∗∗ respectively) but shorter scope and post-procedure times compared with the GA group times (P < 0.001∗∗ and P < 0.001∗∗ respectively). Younger children had a deeper level of sedation for an extended period under BAMS. The costs for the sedation services and the complication rates were lower in the BAMS group compared with the GA group. Conclusion: Our study demonstrated the feasibility of BAMS in children. FB under BAMS had an advantage of lower cost and fewer procedural complications compared with FB under GA. Despite that, the safety of BAMS could not be conclusively established from this retrospective study. Moreover, BAMS can potentially compromise the diagnostic yield because the bronchoscopist is also responsible for monitoring sedation and managing the airway.",
author = "Pritish Mondal and Priti Dalal and Niruja Sathiyadevan and Snyder, {David M.} and Satyanarayan Hegde",
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Flexible Bronchoscopy under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia : A Comparative Study in Children. / Mondal, Pritish; Dalal, Priti; Sathiyadevan, Niruja; Snyder, David M.; Hegde, Satyanarayan.

In: Pediatric, Allergy, Immunology, and Pulmonology, Vol. 31, No. 3, 01.09.2018, p. 166-173.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Flexible Bronchoscopy under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia

T2 - A Comparative Study in Children

AU - Mondal, Pritish

AU - Dalal, Priti

AU - Sathiyadevan, Niruja

AU - Snyder, David M.

AU - Hegde, Satyanarayan

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with a 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, complications, and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS as compared with FB under GA in a similar setting. Methods: We performed a retrospective chart review to compare BAMS versus GA for FB in children. We recruited BAMS children (n = 295) from University of Florida (UF) Health Shands Children's Hospital, and GA children (n = 100) from Penn State Children's Hospital (PSHCH). Both the groups had similar indications, complexities, and procedural environments. Comparisons of various time-intervals including preprocedure time, sedation-induction time, scope time, and post-procedure time among different BAMS versus GA age-groups were the primary outcomes. The secondary outcomes were the determination of the rates of complications, the dosages of sedative/anesthetic, cost-effectiveness, and sedation patterns under BAMS. Results: FB under BAMS required significantly higher preprocedure times and sedation-induction times (P < 0.001∗∗ and P < 0.001∗∗ respectively) but shorter scope and post-procedure times compared with the GA group times (P < 0.001∗∗ and P < 0.001∗∗ respectively). Younger children had a deeper level of sedation for an extended period under BAMS. The costs for the sedation services and the complication rates were lower in the BAMS group compared with the GA group. Conclusion: Our study demonstrated the feasibility of BAMS in children. FB under BAMS had an advantage of lower cost and fewer procedural complications compared with FB under GA. Despite that, the safety of BAMS could not be conclusively established from this retrospective study. Moreover, BAMS can potentially compromise the diagnostic yield because the bronchoscopist is also responsible for monitoring sedation and managing the airway.

AB - Background: Flexible bronchoscopy (FB) can be performed under bronchoscopist administered moderate sedation (BAMS) with a 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, complications, and diagnostic yield. The primary objective of our study was to evaluate the safety, time efficiency, and cost-effectiveness of FB under BAMS as compared with FB under GA in a similar setting. Methods: We performed a retrospective chart review to compare BAMS versus GA for FB in children. We recruited BAMS children (n = 295) from University of Florida (UF) Health Shands Children's Hospital, and GA children (n = 100) from Penn State Children's Hospital (PSHCH). Both the groups had similar indications, complexities, and procedural environments. Comparisons of various time-intervals including preprocedure time, sedation-induction time, scope time, and post-procedure time among different BAMS versus GA age-groups were the primary outcomes. The secondary outcomes were the determination of the rates of complications, the dosages of sedative/anesthetic, cost-effectiveness, and sedation patterns under BAMS. Results: FB under BAMS required significantly higher preprocedure times and sedation-induction times (P < 0.001∗∗ and P < 0.001∗∗ respectively) but shorter scope and post-procedure times compared with the GA group times (P < 0.001∗∗ and P < 0.001∗∗ respectively). Younger children had a deeper level of sedation for an extended period under BAMS. The costs for the sedation services and the complication rates were lower in the BAMS group compared with the GA group. Conclusion: Our study demonstrated the feasibility of BAMS in children. FB under BAMS had an advantage of lower cost and fewer procedural complications compared with FB under GA. Despite that, the safety of BAMS could not be conclusively established from this retrospective study. Moreover, BAMS can potentially compromise the diagnostic yield because the bronchoscopist is also responsible for monitoring sedation and managing the airway.

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