Application of dexmedetomidine combined with intravenous general anesthesia in pediatric fiberoptic bronchoscopy

Abstract:

Objective：To investigate the clinical effect of dexmedetomidine combined with intravenous general anesthesia in pediatric fiberoptic bronchoscopy. Methods：A total of 80 children aged 1-3 years who planned to undergo fiberoptic bronchoscopy and had an American Society of Anesthesiologists（ASA） grade of Ⅰ-Ⅱ were enrolled and randomly divided into normal saline group（NS group） and dexmedetomidine group（Dex group），with 40 children in each group. All children were given the inhalation of 2% lidocaine hy－drochloride before examination；the children in the Dex group were given dexmedetomidine with a loading dose of 1 μg/kg at 10 min－utes before induction of anesthesia，and those in the NS group were given the same dose of normal saline. All children were given in－travenous general anesthesia，and spontaneous breathing was reserved for nasopharyngeal oxygen therapy. Heart rate（HR），respiration rate（RR），noninvasive mean arterial blood pressure（MAP），and pulse oxygen saturation（SpO2） were recorded before the entrance of bronchoscope（T1），at the time when the bronchoscope reached the pharynx（T2），the glottis（T3），and the carina（T4），and at 10 minutes of the examination（T5）. Related adverse events were observed during fiberoptic bronchoscopy，such as bucking，body movement，glottic spasm，airway spasm，severe hypoxia，and car－diopulmonary resuscitation. The time of examination，awakening time，times and dosage of additional administration of general anesthetics，pediatric anesthesia emergence delirium scale（PAED） score at the time of discharge from operating room，and degree of satisfaction. Results：There were no significant differences in general con－ditions between the two groups（P>0.05）. The NS group had a significant increase in MAP at T2，T3，T4，and T5 and a significant in－crease in HR at T2，T3，and T4，while the Dex group had a significant increase in MAP at T4（P<0.05）. Compared with the NS group，the Dex group had significant reductions in MAP at T2，T3，T4，and T5 and HR at T2，T3，and T4（P<0.05），significantly lower times and dosage of additional administration of general anesthetics and incidence rates of adverse events，and significantly shorter time of examination and awakening time（P<0.05），as well as a significantly lower PAED score at the time of discharge from operating room（P<0.05）. There was no significant difference in degree of satisfaction between the two groups（P>0.05）. Conclusion：Dexmedetomidine is safe and effective in intravenous general anesthesia for infants and children during fiberoptic bronchoscopy. It can stabilize vital signs，reduce the dosage of general anesthetics and the incidence rates of intraoperative adverse events and postoperative agitation，and shorten the time of examination and awakening time