Fluoroscopic-assisted endobronchial intubation for single-lung ventilation in infants.

OBJECTIVE: Review our institutional experience with an alternative to fiberoptic-guided endobronchial intubation. AIM: The aim of this retrospective cohort study was to present our experience with the use of fluoroscopy to facilitate endobronchial lung isolation in infants undergoing thoracoscopic procedures. BACKGROUND: Anesthesiologists are more frequently being asked to anesthetize infants and small children for thoracoscopic surgery. Typically, endobronchial intubation or bronchial blockers are utilized to achieve lung isolation during these procedures. However, sometimes small and complicated anatomy can make this challenging. METHODS: Respective chart review over a 13-month period of infants undergoing thoracoscopic excision of congenital lung lesions at the Children's Hospital of Philadelphia. Rate of success in achieving lung isolation along with time of fluoroscopy exposure were recorded. RESULTS: Twenty infants had thoracoscopic lung surgery attempted during the period of the review. Lung isolation was successfully achieved in all of the patients. The average exposure to fluoroscopy was 83.7 s (range 20-320 s). CONCLUSIONS: Fluoroscopic aided lung isolation is a reliable and effective alternative method to the use of fiberoptic bronchoscope for endobronchial intubation in infants.

Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children's hospital.

BACKGROUND: Sedation of children is administered by nonanaesthesiologists in a variety of locations within our children's hospital. The purpose of this study was to assess the depth of sedation administered to children in four locations using the Bispectral Index (BIS) and the University of Michigan Sedation Scale (UMSS). METHODS: Eighty-six children under the age of 12 years undergoing procedures with conscious or deep sedation were enrolled. The study included patients undergoing cardiac catheterization, computerized tomography imaging, gastrointestinal endoscopy, and dental procedures. Sedation for each procedure was based on departmental protocols and preferences; the study did not dictate choice or dose of drugs. An independent observer applied the UMSS sedation scale at 10 min intervals for 1 h. The observer and the personnel administering sedation were blinded to the BIS score, which was recorded continuously. RESULTS: The goal of either conscious or deep sedation was attained in 53% (BIS) and 72% (UMSS) of patients. Depth consistent with general anaesthesia was observed in 35% (BIS) and 0% (UMSS), and an awake state was observed in 12% (BIS) and 28% (UMSS). About 8% of patients experienced desaturation and airway events associated with deeper levels of sedation. CONCLUSIONS: Our data demonstrate wide variations in depth of sedation attained in the hospital. The goal of either conscious or deep sedation was not achieved in a significant number of children. This is a therapeutic failure that requires reassessment of sedation protocols and investigation of new approaches.

Validation of the bispectral index monitor during conscious and deep sedation in children.

UNLABELLED: In this study, we tested the validity of the bispectral index (BIS) monitor during conscious and deep sedation of children by comparing it with the University of Michigan Sedation Scale (UMSS), a validated observational pediatric sedation scale. Eighty-six children <12 yr of age were enrolled in this observational study. The subjects underwent conscious or deep sedation administered by non-anesthesiologists for diagnostic or therapeutic procedures in four departments in a children's hospital. Sedation medications varied among departments and were not controlled by the study protocol. An independent observer derived a UMSS score at 10-min intervals for 1 h during sedation; personnel administering sedation medications and performing the procedures were blinded to the BIS and UMSS scores. Significant correlation between BIS scores and UMSS scores was found (r = -0.704, P < 0.0001), including in subjects <6 mo of age (n = 6) (r = -0.761, P < 0.001). Poor correlation was found when ketamine or an oral combination of chloral hydrate, hydroxyzine, and meperidine were used for sedation. We conclude that BIS correlates well with UMSS scores and may be a valid measure of conscious and deep sedation in children. IMPLICATIONS: We compared bispectral index scores with a validated observational scale of conscious and deep sedation in children and found significant correlation. We conclude that the bispectral index may be a valid measurement of depth of sedation in children.