Original ArticleRespiratory complications of propofol, sevoflurane, and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years: a randomized trial

doi:10.12122/j.issn.1673-4254.2024.09.01

摘要/Abstract

摘要：

Objective To evaluate the effect of propofol, sevoflurane, and dexmedetomidine on respiratory complications in children undergoing fiberoptic bronchoscopy (FOB). Methods This double-blind randomized clinical trial was conducted among 120 children aged 1 month to 3 years undergoing FOB. The patients were randomized into 3 groups (n=40) for anesthesia induction with sevoflurane inhalation, 1 mg/kg propofol, or 1 µg/kg dexmedetomidine before bronchoscopy, and the changes in hemodynamic parameters, sedation level, and respiratory complications during and after the procedure were assessed. Results The patients' heart rate during bronchoscopy was significantly lower and the mean arterial blood pressure significantly higher in dexmedetomidine group than in sevoflurane and propofol groups (P<0.05). Cough during bronchoscopy did not occur in any of the cases in propofol group, while the highest frequency of cough was recorded in dexmedetomidine group. The incidence of laryngospasm in the propofol group (12.5%) was significantly lower than those in sevoflurane and dexmedetomidine groups (30% and 32.5%, respectively) (P<0.05). Conclusion Sevoflurane and propofol are safe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve better sedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

关键词: fiberoptic bronchoscopy, propofol, sevoflurane, dexmedetomidine, children

Abstract:

Key words: fiberoptic bronchoscopy, propofol, sevoflurane, dexmedetomidine, children

. Original ArticleRespiratory complications of propofol, sevoflurane, and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years: a randomized trial[J]. 南方医科大学学报, 2024, 44(9): 1631-1636.

Shafa Amir, Montasery Mohammad, Shahhosseini Sedighe, Keivanfar Majid, Mehr Asieh Maghami, Babaei Mahtab Ebrahim, Jafari Mohammad. Original ArticleRespiratory complications of propofol, sevoflurane, and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years: a randomized trial[J]. Journal of Southern Medical University, 2024, 44(9): 1631-1636.

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参考文献 24

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Characteristics	Dexmedetomidine group （n=40）	Sevofluranegroup （n=40）	Propofol group（n=40）	P
Sex ［n （%）］
Boy	27（67.5%）	33（82.5%）	22（55.0%）	0.052
Girl	13（32.5%）	7（17.5%）	18（45.0%）	0.052
Age （year， Mean±SD）	1.40±1.33	1.43±1.73	1.38±1.40	0.989
Weight （kg， Mean±SD）	9.97±5.21	8.37±5.08	8.16±3.38	0.100
Duration of bronchoscopy （min， Mean±SD）	37.24±4.14	38.18±5.05	38.70±4.23	0.278

Characteristics	Dexmedetomidine group （n=40）	Sevofluranegroup （n=40）	Propofol group（n=40）	P
Sex ［n （%）］
Boy	27（67.5%）	33（82.5%）	22（55.0%）	0.052
Girl	13（32.5%）	7（17.5%）	18（45.0%）	0.052
Age （year， Mean±SD）	1.40±1.33	1.43±1.73	1.38±1.40	0.989
Weight （kg， Mean±SD）	9.97±5.21	8.37±5.08	8.16±3.38	0.100
Duration of bronchoscopy （min， Mean±SD）	37.24±4.14	38.18±5.05	38.70±4.23	0.278

Parameter	Time point	Dexmedetomidine group （n=40）	Sevoflurane group （n=40）	Propofol group （n=40）	P₁	P₂	P₃
MAP （mmHg）	Baseline	98.37±7.28	96.95±17.19	96.76±10.36	0.098	0.096	0.545
	T₀	98.83±9.20	97.95±14.30	95.73±10.93	0.744	0.173	0.438
	T₅	94.37±11.53	65.73±12.05	70.03±10.43	<0.001	<0.001	0.099
	T₁₀	93.47±14.10	69.35±13.41	70.00±12.33	<0.001	<0.001	0.834
	T₁₅	88.58±6.93	64.88±9.54	69.41±14.83	0.020	<0.001	0.108
	R₀	93.67±10.42	66.97±7.44	66.73±11.94	<0.001	<0.001	0.923
	R₁₅	92.38±14.64	65.73±9.41	67.13±9.15	<0.001	<0.001	0.617
	R₃₀	92.05±17.36	66.27±8.82	70.32±6.91	<0.001	<0.001	0.177
P₄		<0.001	0.007	0.001
HR （min^-1）	Baseline	127.08±18.09	138.85±23.69	128.63±43.69	0.088	0.222	0.104
	T₀	130.69±23.65	140.34±22.01	136.53±21.29	0.061	0.249	0.434
	T₅	107.44±19.02	139.71±19.07	130.78±19.20	<0.001	<0.001	0.040
	T₁₀	114.49±24.03	141.88±22.33	130.40±24.73	<0.001	0.003	0.031
	T₁₅	118.36±22.44	141.24±31.18	128.48±15.41	0.002	0.021	0.022
	R₀	121.46±14.69	134.47±25.54	139.25±24.17	0.015	<0.001	0.363
	R₁₅	122.62±16.22	129.23±24.45	137.97±21.04	0.021	0.002	0.100
	R₃₀	124.64±14.45	131.20±24.88	133.50±21.81	0.189	0.063	0.650
P₄		<0.001	0.026	<0.001
SPO₂ （%）	Baseline	99.85±3.05	99.27±1.45	97.23±4.34	0.891	0.085	0.400
	T₀	97.87±3.25	98.90±1.59	98.10±3.91	0.104	0.078	0.241
	T₅	96.54±2.98	96.44±3.29	97.15±5.37	0.912	0.501	0.428
	T₁₀	97.21±2.35	97.61±2.84	96.25±6.01	0.658	0.300	0.136
	T₁₅	95.85±3.41	94.90±7.11	96.72±4.93	0.508	0.520	0.232
	R₀	98.36±1.81	98.23±5.00	95.95±5.59	0.906	0.018	0.035
	R₁₅	97.95±2.60	99.23±1.19	97.71±2.75	0.027	0.659	0.010
	R₃₀	97.41±2.18	99.03±1.16	97.67±3.09	0.005	0.636	0.020
P₄		<0.001	0.001	0.019

Parameter	Time point	Dexmedetomidine group （n=40）	Sevoflurane group （n=40）	Propofol group （n=40）	P₁	P₂	P₃
MAP （mmHg）	Baseline	98.37±7.28	96.95±17.19	96.76±10.36	0.098	0.096	0.545
	T₀	98.83±9.20	97.95±14.30	95.73±10.93	0.744	0.173	0.438
	T₅	94.37±11.53	65.73±12.05	70.03±10.43	<0.001	<0.001	0.099
	T₁₀	93.47±14.10	69.35±13.41	70.00±12.33	<0.001	<0.001	0.834
	T₁₅	88.58±6.93	64.88±9.54	69.41±14.83	0.020	<0.001	0.108
	R₀	93.67±10.42	66.97±7.44	66.73±11.94	<0.001	<0.001	0.923
	R₁₅	92.38±14.64	65.73±9.41	67.13±9.15	<0.001	<0.001	0.617
	R₃₀	92.05±17.36	66.27±8.82	70.32±6.91	<0.001	<0.001	0.177
P₄		<0.001	0.007	0.001
HR （min^-1）	Baseline	127.08±18.09	138.85±23.69	128.63±43.69	0.088	0.222	0.104
	T₀	130.69±23.65	140.34±22.01	136.53±21.29	0.061	0.249	0.434
	T₅	107.44±19.02	139.71±19.07	130.78±19.20	<0.001	<0.001	0.040
	T₁₀	114.49±24.03	141.88±22.33	130.40±24.73	<0.001	0.003	0.031
	T₁₅	118.36±22.44	141.24±31.18	128.48±15.41	0.002	0.021	0.022
	R₀	121.46±14.69	134.47±25.54	139.25±24.17	0.015	<0.001	0.363
	R₁₅	122.62±16.22	129.23±24.45	137.97±21.04	0.021	0.002	0.100
	R₃₀	124.64±14.45	131.20±24.88	133.50±21.81	0.189	0.063	0.650
P₄		<0.001	0.026	<0.001
SPO₂ （%）	Baseline	99.85±3.05	99.27±1.45	97.23±4.34	0.891	0.085	0.400
	T₀	97.87±3.25	98.90±1.59	98.10±3.91	0.104	0.078	0.241
	T₅	96.54±2.98	96.44±3.29	97.15±5.37	0.912	0.501	0.428
	T₁₀	97.21±2.35	97.61±2.84	96.25±6.01	0.658	0.300	0.136
	T₁₅	95.85±3.41	94.90±7.11	96.72±4.93	0.508	0.520	0.232
	R₀	98.36±1.81	98.23±5.00	95.95±5.59	0.906	0.018	0.035
	R₁₅	97.95±2.60	99.23±1.19	97.71±2.75	0.027	0.659	0.010
	R₃₀	97.41±2.18	99.03±1.16	97.67±3.09	0.005	0.636	0.020
P₄		<0.001	0.001	0.019

Time point	Dexmedetomidine group （n=40）	Sevoflurane group （n=40）	Propofol group （n=40）	P₁	P₂	P₃
T₀	2.10±0.31	2.32±0.91	3.05±0.96	0.225	<0.001	<0.001
T₅	2.77±0.43	3.15±0.53	3.80±0.56	0.001	<0.001	<0.001
T₁₀	2.38±0.49	2.90±0.54	3.62±0.59	<0.001	<0.001	<0.001
T15	3.00±0.56	3.16±0.60	3.24±0.78	0.400	0.678	0.609
R₀	2.26±0.44	2.58±0.65	3.09±0.56	0.022	<0.001	0.001
R₁₅	1.90±0.79	2.33±0.82	2.97±0.66	0.028	<0.001	0.002
R₃₀	1.64±0.87	1.70±0.86	1.98±0.75	0.797	0.065	0.125
P₄	<0.001	0.001	<0.001