Document Detail

Nebulized lidocaine alone or combined with fentanyl as a premedication to general anesthesia in spontaneously breathing pediatric patients undergoing rigid bronchoscopy.
MedLine Citation:
PMID:  23190026     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Pediatric bronchoscopy is an intensely stimulating procedure that requires a deep level of anesthesia to prevent hemodynamic overstimulation and straining. Topical anesthesia of the airway may be a beneficial component of the anesthetic technique to achieve adequate depth without residual sedation. Experimental evidence suggests that in addition to its central effects, locally applied opioids elicit potent analgesic effects. METHODS: Forty-five patients aged 1-6 years scheduled for rigid bronchoscopy for foreign body removal were selected and subjected preoperatively to a nebulizer setting according to its components patients were divided into three groups. Group A: Nebulized solution contains 4 mg·kg(-1) lidocaine 1%. Group B: Nebulized solution contains 4 mg·kg(-1) lidocaine 1% plus 2 μg·kg(-1) fentanyl. Group C: Nebulized solution contains 0.9% normal saline. Anesthesia was induced with 8% sevoflurane in 100% oxygen and maintained with continuous infusion of propofol 200 μg·kg(-1) . Increments of 500 μg·kg(-1) propofol were given to the patient in case of straining or coughing. Patients were followed for the hemodynamics, the intraoperative difficulties, postoperative sedation score, time to full wakefulness and the postoperative complications. RESULTS: The hemodynamic parameters were much more stable in the fentanyl group relative to the other two groups. Also, the incidence of intraoperative difficulties was less significantly evident among patients in the fentanyl group (As regards cough P(1)  = 0.003, P(2)  = 0.0001, As regards the need to manual ventilation P(1)  = 0.037, P(2)  = 0.001, As regards Propofol increments P(1)  = 0.001, P(2)  = 0.001 where P(1) refers to the fentanyl group relative to the lidocaine group, and P(2) refers to fentanyl group relative to the placebo group). The postoperative sedation score was significantly higher, and the time to full wakefulness was significantly prolonged among patients in the fentanyl group relative to the other groups (P = 0.0001). CONCLUSION: It is concluded that preoperative nebulized fentanyl reduces the hemodynamic response to bronchoscopy and decreases the intraoperative coughing in response to surgical manipulation without significant side effects except prolonged time to full wakefulness of patients.
Moustafa A Moustafa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-28
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  -     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Anesthesia and Surgical Intensive Care, Faculty of medicine, Alexandria university, Alexandria, Egypt.
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