Bedside fiberoptic bronchoscopy can be safely performed under conscious sedation

Bedside fiberoptic bronchoscopy aids in the diagnosis and treatment of various respiratory conditions in critically ill patients. Adequate sedation is of paramount importance to ensure the success and safety of the procedure. In our institution, flexible fiberoptic bronchoscopy is done under conscious sedation with a benzodiazepine in the majority of cases in the paediatric intensive care unit.

We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001. The median age was 29 months (range 1–306 months). Fifty-five percent (n = 59) were done via the endotracheal tube, 40% (n = 43) transnasally while 5% (n = 5) were done via a tracheostomy. The Olympus fiberoptic bronchoscope (model no. BFXP40) with a 2.8 mm outer diameter was used.

Forty-six percent (n = 49) of procedures were done with intravenous midazolam sedation with a dose of 0.2–0.4 mg/kg. Twenty-six percent (n = 28) were performed with no parenteral sedation as these were mostly comatosed intubated patients. Eight percent (n = 8) of procedures required sedation with a combination of intravenous midazolam, pethidine and chlorpromazine. The remaining patients underwent the procedure with their existing sedative infusions. Topical anaesthesia was used in all procedures. All patients were continuously monitored with cardiorespiratory and pulse oximetry monitors. Only 5.6% (n = 6) developed transient desaturation. One patient had transient hypotension probably related to sedation, one developed airway bleeding because of underlying thrombocytopenia and one developed transient post-procedure stridor. 3.7% (n = 4) had their sedation reversed with flumazenil or naloxone.

In conclusion, bedside flexible fiberoptic bronchoscopy under intravenous conscious sedation in children in the paediatric intensive care unit is safe. Proper monitoring and trained personnel are however important to avoid potential complications.