title: Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation.
abstract: BACKGROUND
  Flexible fiberoptic bronchoscopy is an important diagnostic tool for pediatric pulmonologists. Because of its favorable respiratory profile, ketamine has become a popular sedative for this procedure, but may be associated with unpleasant emergence reactions in the older child. Remifentanil is a newer, ultra-short acting opioid that has been shown to provide effective sedation and cough suppression for fiberoptic bronchoscopy when combined with intermittent propofol boluses. However, delivery of these agents as a combined, single infusion has not been described.
  
  
  METHODS
  Children > or =2 years of age undergoing fiberoptic bronchoscopy were enrolled. Remifentanil was mixed in a single syringe with undiluted propofol giving final drug concentrations of 10 mg x ml(-1) of propofol and 15-20 microg x ml(-1) of remifentanil. Sedation was induced with a bolus of approximately 0.1 ml x kg(-1) of this mixture and maintained by titrating the drip throughout the procedure. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.
  
  
  RESULTS
  Fifteen patients aged 9.0 +/- 5.3 years were sedated. Sedation was induced with 1.2 +/- 0.4 mg x kg(-1) propofol (2.4 +/- 0.8 microg x kg(-1) remifentanil) and maintained with 4.1 +/- 1.8 mg x kg(-1) x h(-1) propofol (0.13 +/- 0.06 microg x kg(-1) x min(-1) remifentanil). Five patients received low-dose ketamine to augment sedation. The maximal decrease in respiratory rate was 6.1 +/- 5.3 b x min(-1) (27.6 +/- 21%) and no patient became hypoxemic. All procedures were completed easily without significant complication. Patients recovered to baseline 13.3 +/- 8.5 min following infusion discontinuation.
  
  
  CONCLUSIONS
  A remifentanil/propofol mixture provided effective sedation and rapid recovery in pediatric patients undergoing fiberoptic bronchoscopy.
authors.affiliation: Department of Child Health, The University of Missouri-Columbia, Columbia, MO 65212, USA. berkenboschj@health.missouri.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Berkenbosch
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Graff
authors.forename: James M
authors.initials: JM
authors.lastname: Stark
authors.forename: Zarah
authors.initials: Z
authors.lastname: Ner
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D005336:Fiber Optic Technology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D010100:Oxygen; D015742:Propofol