Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy.
OBJECTIVE
To describe our experience with ketamine sedation during infant flexible fiberoptic bronchoscopy.


METHODS
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 <or= 6 months or > 6 months of age and between infants with upper vs lower airway symptoms were compared by chi(2) 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.
Department of Child Health, The University of Missouri-Columbia, 65212, USA. berkenboschj@health.missouri.edu
John W
JW
Berkenbosch
Gavin R
GR
Graff
James M
JM
Stark
D000778:Anesthetics, Dissociative / Q000008:administration & dosage*; D001999:Bronchoscopy / Q000009:adverse effects; D016292:Procedural Sedation; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage
D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam