Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children - a prospective evaluation

• Published in: Pediatric anesthesia Vol. 20; no. 5; pp. 434 - 438
• Main Authors: MALHERBE, STEPHAN, WHYTE, SIMON, SINGH, PERMENDRA, AMARI, ERICA, KING, ASHLEE, MARK ANSERMINO, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2010
• Subjects: airway endoscopy; Anesthesia, Intravenous - adverse effects; Anesthetics, Intravenous - adverse effects; Blood Pressure; Bronchoscopy; Carbon Dioxide - blood; Child; Child, Preschool; Electrocardiography; Electroencephalography - drug effects; Feasibility Studies; Female; Humans; Infant; Infant, Newborn; Male; Oxygen - blood; Piperidines - adverse effects; propofol; Propofol - adverse effects; Prospective Studies; remifentanil; Respiratory Mechanics - physiology; Respiratory System - surgery; spontaneous respiration; total intravenous anesthesia; transcutaneous carbon dioxide
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2010.03290.x

Summary Introduction:  Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration. Methods:  We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO2 (TcCO2), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded. Results:  Forty‐one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 microlaryngobronchoscopies, including 18 LASER treatments, were performed. The mean (sd) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO2 recorded during the procedures was 62.8 ± 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed. Conclusion:  TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children.