Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy

John W. Berkenbosch, Gavin R. Graff, James M. Stark

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: To describe our experience with ketamine sedation during infant flexible fiberoptic bronchoscopy. Design: Retrospective chart review. Infants were sedated with midazolam and ketamine with or without fentanyl. The sedation regimen, final procedure performed, procedure duration, and complications were recorded. Complication rates between infants ≤ 6 months or > 6 months of age and between infants with upper vs lower airway symptoms were compared by χ2 test with a contingency table. Results: Fifty-nine procedures were performed in 55 patients aged 6.1 ± 3.1 months (mean ± SD). Sedation was achieved with ketamine and midazolam (n = 30) or ketamine, midazolam, and fentanyl (n = 29). Bronchoscopy with BAL was performed in 44 patients and bronchoscopy alone in 3 patients. In 11 patients, severe upper airway obstruction and/or anomalies prevented subglottic passage of the bronchoscope. One patient could not be adequately sedated. There were no major complications. Minor complications occurred in 14 patients (23.7%), most commonly mild hypoxemia (n = 9). Brief central apnea developed in three patients. Complication rates were unaffected by age or indication for bronchoscopy. Conclusions: Infant flexible fiberoptic bronchoscopy can be safely and effectively performed using ketamine sedation. Complications, especially mild hypoxemia, appear more common in infants, likely due to smaller airway diameter. Regardless of the sedative(s) used, additional vigilance is required when performing bronchoscopy in this population.

Original languageEnglish (US)
Pages (from-to)1132-1137
Number of pages6
JournalCHEST
Volume125
Issue number3
DOIs
StatePublished - Mar 2004

Fingerprint

Ketamine
Bronchoscopy
Safety
Midazolam
Fentanyl
Central Sleep Apnea
Bronchoscopes
Dimercaprol
Airway Obstruction
Hypnotics and Sedatives
Population

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Berkenbosch, John W. ; Graff, Gavin R. ; Stark, James M. / Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy. In: CHEST. 2004 ; Vol. 125, No. 3. pp. 1132-1137.
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abstract = "Objective: To describe our experience with ketamine sedation during infant flexible fiberoptic bronchoscopy. Design: Retrospective chart review. Infants were sedated with midazolam and ketamine with or without fentanyl. The sedation regimen, final procedure performed, procedure duration, and complications were recorded. Complication rates between infants ≤ 6 months or > 6 months of age and between infants with upper vs lower airway symptoms were compared by χ2 test with a contingency table. Results: Fifty-nine procedures were performed in 55 patients aged 6.1 ± 3.1 months (mean ± SD). Sedation was achieved with ketamine and midazolam (n = 30) or ketamine, midazolam, and fentanyl (n = 29). Bronchoscopy with BAL was performed in 44 patients and bronchoscopy alone in 3 patients. In 11 patients, severe upper airway obstruction and/or anomalies prevented subglottic passage of the bronchoscope. One patient could not be adequately sedated. There were no major complications. Minor complications occurred in 14 patients (23.7{\%}), most commonly mild hypoxemia (n = 9). Brief central apnea developed in three patients. Complication rates were unaffected by age or indication for bronchoscopy. Conclusions: Infant flexible fiberoptic bronchoscopy can be safely and effectively performed using ketamine sedation. Complications, especially mild hypoxemia, appear more common in infants, likely due to smaller airway diameter. Regardless of the sedative(s) used, additional vigilance is required when performing bronchoscopy in this population.",
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Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy. / Berkenbosch, John W.; Graff, Gavin R.; Stark, James M.

In: CHEST, Vol. 125, No. 3, 03.2004, p. 1132-1137.

Research output: Contribution to journalArticle

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