title: Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine.
abstract: OBJECTIVE
  Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy.
  
  
  METHODS
  Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated.
  
  
  RESULTS
  The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K.
  
  
  CONCLUSIONS
  Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period.
authors: Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors: Mefkur
authors: M
authors: Bakan
authors: Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors: Ufuk
authors: U
authors: Topuz
authors: Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors: Tarik
authors: T
authors: Umutoglu
authors: Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
authors: Gokhan
authors: G
authors: Gundogdu
authors: Department of Pediatric Surgery, Derince Training and Research Hospital, Kocaeli, Turkey.
authors: Zekeriya
authors: Z
authors: Ilce
authors: Department of Pediatric Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
authors: Mehmet
authors: M
authors: Elicevik
authors: Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
authors: Guner
authors: G
authors: Kaya
mesh_terms: D000771:Anesthesia, Intravenous / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D000077208:Remifentanil
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil; D015742:Propofol