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The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients^*

A Randomized, Double-Blind, Controlled Study

^* From the Service de Pneumologie Pédiatrique et INSERM 213 (Drs. Fauroux and Clément), Hôpital d’Enfants Armand Trousseau, Paris; Air Liquide Santé International (Dr. Onody), Paris; and Unité de Traitement de la Douleur (Drs. Gall and Tourniaire), Hôpital d’Enfants Armand Trousseau, Paris; and Département de Statistique Médicale (Dr. Koscielny), Institute Gustave Roussy, Villejuif, France.

Correspondence to: Brigitte Fauroux, MD, PhD, Service de Pneumologie Pédiatrique and INSERM 213, Hôpital d’Enfants Armand Trousseau, 28 avenue du Docteur Arnold Netter, 75012 Paris, France; e-mail: brigitte.fauroux{at}trs.ap-hop-paris.fr

Study objectives: The aim of the study was to evaluate the efficacy and safety of premixed 50% nitrous oxide and oxygen on the quality of sedation and pain control during fiberoptic bronchoscopy (FB) in children.

Design: A prospective, randomized, double-blind study.

Setting: Pediatric pulmonary department in a pediatric tertiary university hospital.

Patients: One hundred five children aged 1 month to 18 years.

Interventions: Patients inhaled after sedation and local anesthesia either premixed 50% nitrous oxide and oxygen (nitrous oxide group) or premixed 50% nitrogen and oxygen (control group) during FB.

Measurement and results: The rate of failure was significantly greater in the control group (62%) than in the nitrous oxide group (21%, p = 0.00003). The efficacy of premixed 50% nitrous oxide and oxygen was also demonstrated with higher satisfaction scores (p = 0.000001), lower Children’s Hospital of Eastern Ontario Pain Scores (p = 0.002), better visual analog scale ratings (p = 0.03), and improved behavior scores. Side effects were minor and similar in both groups.

Conclusions: This study demonstrates the improved efficacy of sedation, pain control, and safety of premixed 50% nitrous oxide and oxygen for FB in children.

Key Words: children • Children’s Hospital of Eastern Ontario Pain Score • fiberoptic bronchoscopy • pain control • premixed 50% nitrous oxide and oxygen • safety • sedation • videotape recording

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