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Original Research

Open Access

Safety and effectiveness of deep sedation in pediatric patients undergoing flexible fibroscopy in spontaneous breathing

  • Federica Tosi1
  • Giorgio Conti2
  • Rossano Festa1
  • Aldo Mancino2
  • Marco Rossi1
  • Antonio Chiaretti3
  • Lavinia Capossela3
  • Antonio Gatto4

1Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

2Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

3Institute of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS - Università Cattolica Sacro Cuore, Rome, Italy

4Institute of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

DOI: 10.22514/sv.2021.049 Vol.17,Issue 4,July 2021 pp.60-65

Submitted: 19 January 2021 Accepted: 25 February 2021

Published: 08 July 2021

*Corresponding Author(s): Antonio Gatto E-mail: antonio.gatto@policlinicogemelli.it

Abstract

Invasive diagnostics and minor surgical procedures with deep sedation on pediatric patients, such as fibroscopic examination, have increased over the past decade. The aim of this study was to evaluate the usefulness and safety of an anesthesiological technique, based on the use of midazolam and ketamine, conducted in spontaneous breathing on a population of pediatric patients with suspected tracheobronchial pathologies. Pediatric patients from birth to 18 years old who underwent sedation diagnostic fibroscopy between April 2018 and March 2019, were enrolled. The anesthesiological technique provided was the intravenous administration of midazolam 0.2 mg/kg and ketamine 2 mg/kg in spontaneous breathing using a face mask with support of O2 and air. Vital signs such as Heart rate (HR), Systolic and Diastolic blood pressure (PAS and PAD) and Arterial oxygen saturation were recorded at the beginning of the procedure, 10 minutes and 30 minutes from the start. Other parameter evaluated were patient’s level of consciousness, quality of the procedure, major and minor complications, adequate recovery of the waking state. Sixteen patients were enrolled, 12 males and 4 females aged between 2 days of life and 7 years. Laryngomalacia tracheomalacia, tracheoesophageal fistula, and congenital airway malformations were the most frequent diseases. As for vital signs: the HR has gone from an average value of 133.4 ± 16.26 bpm at T0 to an average value of 129.3 ± 16.55 bpm at T10 and 133.7 ± 17.35 bpm at T30; PAS and PAD had not significant variations. Among drugs available for the fibroscopic examinations, the combined use of intravenous midazolam 0.2 mg/kg and ketamine 2 mg/kg is safe and well tolerated, reducing the anxiety associated with the examination, without major complications. The current literature is lacking in studies that have included such small and low weight patients. It would be interesting to make a comparison between various sedation techniques in order to identify the safest for the pediatric population.


Keywords

Sedation; Deep; Pediatric; Bronchoscopy


Cite and Share

Federica Tosi,Giorgio Conti,Rossano Festa,Aldo Mancino,Marco Rossi,Antonio Chiaretti,Lavinia Capossela,Antonio Gatto. Safety and effectiveness of deep sedation in pediatric patients undergoing flexible fibroscopy in spontaneous breathing. Signa Vitae. 2021. 17(4);60-65.

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