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* From the Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD.
Correspondence to: Frederick P. Ognibene, MD, FCCM, FACP, National Institutes of Health, Warren G. Magnuson Clinical Center, Critical Care Medicine Department, Building 10, Room 7D43, 10 Center Dr MSC 1662, Bethesda, MD 20892-1662; e-mail: fognibene{at}nih.gov
Study objective: To assess the risk for complications with the use of sedation and analgesia techniques in pediatric fiberoptic bronchoscopy.
Design: A retrospective case series.
Setting: The ICU of a 325-bed tertiary care research hospital.
Patients: Patients from 1 to 18 years of age who underwent fiberoptic bronchoscopy with BAL or transbronchial biopsy between June 1991 and December 1995 and received IV sedation and analgesia.
Interventions: None.
Methods: A retrospective chart review was performed. Extracted data included anesthetics and sedatives used and their per kilogram dosages, procedure durations, and complications including oxygen desaturations < 90%, vital sign alterations that required intervention, and emergence reactions to ketamine.
Results: A total of 103 bronchoscopies were performed on 64
patients. Ketamine was used as the primary anesthetic in 60 procedures
(58%). A combination of fentanyl and midazolam was used in 38 of the
43 remaining procedures. A variety of combinations were used in the
five remaining procedures. Complications occurred in 13 procedures and
included oxygen desaturations, stridor, cough, apnea, and nasal
bleeding. Twelve of the 13 complications occurred in patients with a
diagnosis of HIV infection. Eight of the13 complications involved
children 
3 years of age.
Conclusions: Pediatric
bronchoscopy is a safe and valuable procedure. However, in this study,
anesthetic selection was shown to adversely affect the complication
rate in the subsets of children 3 years of age and with an
underlying diagnosis of HIV infection.
Key Words: anesthesia • BAL • bronchoscopy • complications • fentanyl • ketamine • midazolam • pediatrics • procedures • pulmonary disease • sedation
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