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Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children--a prospective evaluation.
Paediatr Anaesth. 2010 May; 20(5):434-8.PA

Abstract

INTRODUCTION

Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration.

METHODS

We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO(2) (TcCO(2)), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded.

RESULTS

Forty-one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 micro-laryngobronchoscopies, including 18 LASER treatments, were performed. The mean (sd) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO(2) recorded during the procedures was 62.8 +/- 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed.

CONCLUSION

TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children.

Authors+Show Affiliations

Department of Anesthesia, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20337953

Citation

Malherbe, Stephan, et al. "Total Intravenous Anesthesia and Spontaneous Respiration for Airway Endoscopy in Children--a Prospective Evaluation." Paediatric Anaesthesia, vol. 20, no. 5, 2010, pp. 434-8.
Malherbe S, Whyte S, Singh P, et al. Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children--a prospective evaluation. Paediatr Anaesth. 2010;20(5):434-8.
Malherbe, S., Whyte, S., Singh, P., Amari, E., King, A., & Ansermino, J. M. (2010). Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children--a prospective evaluation. Paediatric Anaesthesia, 20(5), 434-8. https://doi.org/10.1111/j.1460-9592.2010.03290.x
Malherbe S, et al. Total Intravenous Anesthesia and Spontaneous Respiration for Airway Endoscopy in Children--a Prospective Evaluation. Paediatr Anaesth. 2010;20(5):434-8. PubMed PMID: 20337953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children--a prospective evaluation. AU - Malherbe,Stephan, AU - Whyte,Simon, AU - Singh,Permendra, AU - Amari,Erica, AU - King,Ashlee, AU - Ansermino,J Mark, Y1 - 2010/03/11/ PY - 2010/3/27/entrez PY - 2010/3/27/pubmed PY - 2010/8/24/medline SP - 434 EP - 8 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 20 IS - 5 N2 - INTRODUCTION: Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration. METHODS: We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO(2) (TcCO(2)), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded. RESULTS: Forty-one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 micro-laryngobronchoscopies, including 18 LASER treatments, were performed. The mean (sd) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO(2) recorded during the procedures was 62.8 +/- 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed. CONCLUSION: TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/20337953/Total_intravenous_anesthesia_and_spontaneous_respiration_for_airway_endoscopy_in_children__a_prospective_evaluation_ L2 - https://doi.org/10.1111/j.1460-9592.2010.03290.x DB - PRIME DP - Unbound Medicine ER -