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Flexible Bronchoscopy Under Bronchoscopist-Administered Moderate Sedation Versus General Anesthesia: A Comparative Study in Children.
Pediatric Allergy, Immunology, and Pulmonology ( IF 0.9 ) Pub Date : 2018-09-28 , DOI: 10.1089/ped.2018.0887
Pritish Mondal 1 , Priti Dalal 2 , Niruja Sathiyadevan 3 , David M Snyder 4 , Satyanarayan Hegde 5
Affiliation  

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.

中文翻译:

支气管镜医师给予的中度镇静与全身麻醉下的柔性支气管镜检查:一项儿童比较研究。

背景:可屈性支气管镜检查 (FB) 可以在支气管镜医师给予咪达唑仑/芬太尼组合的中度镇静 (BAMS) 或全身麻醉 (GA) 下进行。然而,BAMS 在儿童中的结果尚未明确。目前,大多数中心在GA下更倾向于FB。这两种技术都有其优点和缺点,对安全性、并发症和诊断率都有影响。我们研究的主要目的是评估 BAMS 下 FB 与相似环境下 GA 下 FB 的安全性、时间效率和成本效益。方法:我们进行了回顾性图表审查,比较 BAMS 与 GA 治疗儿童 FB 的效果。我们从佛罗里达大学 (UF) Health Shands 儿童医院招募了 BAMS 儿童 (n = 295),从宾夕法尼亚州立大学儿童医院 (PSHCH) 招募了 GA 儿童 (n = 100)。两组都有相似的适应症、复杂性和程序环境。主要结果是比较不同 BAMS 与 GA 年龄组之间的各种时间间隔,包括手术前时间、镇静诱导时间、观察时间和手术后时间。次要结果是确定 BAMS 下的并发症发生率、镇静/麻醉剂量、成本效益和镇静模式。结果:与 GA 组时间相比,BAMS 下的 FB 需要显着更高的术前时间和镇静诱导时间(分别为 P < 0.001** 和 P < 0.001**),但范围和术后时间更短(P < 0.001** 和P < 0.001** 分别)。年幼的儿童在 BAMS 下可以长时间获得更深程度的镇静。与 GA 组相比,BAMS 组的镇静服务费用和并发症发生率较低。结论:我们的研究证明了 BAMS 在儿童中的可行性。与 GA 下的 FB 相比,BAMS 下的 FB 具有成本较低、手术并发症较少的优点。尽管如此,这项回顾性研究仍无法最终确定 BAMS 的安全性。此外,BAMS 可能会影响诊断率,因为支气管镜医师还负责监测镇静和管理气道。
更新日期:2019-11-01
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