Application Of Demedetomidine In Bronchoscopic Removal Of Airway Foreign Body In Children

Objective To study the efficacy and safety of different doses of dexmedetomidine combined with midazolam sedation in bronchoscopic removal of airway foreign body in children.Methods From January 1 to May 30,2018,80 children diagnosed with airway foreign body were admitted to Respiratory Interventional Department,Qilu Children’s Hospital of Shandong University,for bronchoscopic removal.There were 47 boys and 33 girls,aged 1 to 3 years old,weight 9～18 kg,ASA class Ⅰ～Ⅱ.These children were randomly divided into four groups(n=20):group D1,group D2,group D3 and group M.Dexmedetomidine was dropped into the nasal cavity of children in D1,D2 and D3 groups at 3μg/kg,4μg/kg and 5μg/kg respectively 15min before bronchoscopy and 0.9%sodium chloride solution of 0.05ml/kg was dropped into the nasal cavity of group M.After entering bronchoscopy room,all the children were intravenously injected with midazolam 0.4mg/kg.The operation was started when the children fell asleep and heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),pulse oxygen saturation(SpO2),and Narcotrend(NT)sedation depth were monitored during the operation.If the child presented obvious struggle and resistance or frequent severe cough during the operation,propofol of 0.5-1 mg/kg was intravenously injected slowly and repeatedly as a remedial measure.HR,MAP,RR,SpO2,and NT indexes of each group were observed and recorded before nasal administration(TO),15min after nasal administration(T1),immediately before operation(T2),immediately after bronchoscope enter glottis(T3),immediately after grasping the foreign body(T4),and immediately after bronchoscopy(T5).Ramsay sedation effect score and separation state of Ramsay before entering the room were observed and recorded in each group,and also the dose of propofol,operation time,recovery time,and the incidence of respiratory depression,cough,breath holding,laryngeal or bronchospasm,recovery agitation,nausea and vomiting and other complications during and after the operation.Results There were no statistically significant differences between the four groups in gender,age,weight,basal heart rate,basal mean arterial pressure,basal pulse oxygen saturation,operation time,etc.(P>0.05).Before entering the room,there were significant differences in Ramsay sedation effect scores among the four groups.Sedation satisfaction scores of the D1 group,D2 group and D3 group were respectively 70%,75%and 75%,which were significantly higher than that of the M group(P<0.001).The proportion of children in group D1,group D2 and group D3 who had achieved calm or sleep before entering the room was 75%,90%and 100%,respectively,significantly higher than group M(15%),with statistically significant differences(P<0.001).The heart rate of the four groups at each time point was significantly different by pairwise comparison,M group was significantly increased at T1-T5 compared with the D1 group,D2 group and D3 group(P<0.05).Compared with M group,the mean arterial pressure was significantly lower in the D3 group at T1,T4 and T5 points,and also in the D1 group,D2 group and D3 group at T2 and T3 points(P<0.05).Compared with T0,respiratory rate at T4 was significantly reduced in the M group(P<0.05),SpO2 at T5 in the D3 group and at T4 in the M group was significantly reduced(P<0.05),the intensity of narcotic effect(NT)at T1-T5 in the D1 group,D2 group and D3 group and at T2-T5 in the M group decreased to different degrees,with statistically significant difference(P<0.05).Pairwise comparison between the two groups showed that the sedation depth of group D1,group D2 and group D3 at each time point of T1-T5 had difference of different degrees from group M,and the difference was statistically significant(P<0.05).Compared with the M group,the amount of propofol used in the D1 group,the D2 group and the D3 group was significantly reduced.Compared with the D3 group,the amount of propofol used in the D1 group was significantly increased,with statistically significant differences(P<0.05).Pairwise comparison between the four groups showed statistically significant differences in recovery time(P<0.001).The incidence of cough and agitation in M group was significantly higher than that in D2 group and D3 group(P<0.008).There were no statistically significant differences in the incidence of respiratory depression,breathlessness,laryngeal or bronchial spasm and nausea and vomiting in the four groups(P>0.05).Conclusion 1.Preoperative Dexmedetomidine nasal drip has a significant effect on the bronchoscopic removal of airway foreign body in children,which can improve the sedation level and parent-child separation state.With the increase of dose,its sedation and anti-anxiety effects are also significantly increased,but the postoperative recovery time is also significantly extended.Therefore,a dose of 4μg/kg is recommended to achieve sufficient sedation depth without significantly extending the recovery time.2.Dexmedetomidine combined with midazolam is safe bronchoscopic removal of airway foreign body in children.If the child moves or coughs obviously during operation,a small dose of propofol can be administered,which has little effect on the patient’s heart rate,respiratory and hemodynamic status,with no respiratory depression and prolonging the operation time,and can reduce the incidence of adverse events.This approach is worth promoting in clinical use.