Pitfalls in the Use of the Flexible Bronchoscope in Pediatric Patients: ANESTHESIA, SEDATION, AND MONITORING
Inadequate or inappropriate monitoring of the patient during the procedure is another major potential pitfall. Bronchoscopy is fun and interesting. Often everyone in the bronchoscopy suite becomes so engrossed in the endoscopic findings that it is easy to forget about the patient and his physiologic status. Bronchoscopists hypnosis is a real phenomenon! Even with otherwise appropriate electronic monitoring, the patient must be continuously observed by someone other than the bronchoscopist.
Flexible bronchoscopy is usually performed in children with sedation and topical anesthesia rather than with general anesthesia. In my practice, sedative agents are almost always given by the IV route. Unfortunately, sedation of children is fraught with many potential pitfalls. Some of the most common problems include starting the procedure before the child is sufficiently sedated and not using enough sedation to begin with, then trying to achieve sedation after the child has become agitated and excited. Another common pitfall is waiting an insufficient time following the administration of a fractional dose of sedative agent before repeating the dose, thus producing oversedation. Particularly anxious children may require presedation, and it may be very helpful to have IV access established prior to bringing the child to the procedure suite. On the other hand, presedation (with agents such as chloral hydrate or “cardiac cocktail”) may make it difficult to determine how much additional sedative agent may be safely given once the child is in the procedure room. kamagra tablets
Children are very susceptible to suggestion, and attention to hypnotic principles can be very beneficial. Many procedures are much more difficult than they should be, for both the patient and the medical staff, because of inappropriate information which has been given to the patient before or during the procedure. All conversation in the procedure room should be made with an acute awareness of its potential effect on the patient. Such expressions as “hurt,” “pain,” or “oops!” have no place in the bronchoscopy room.
Following bronchoscopy, the patient must be adequately monitored until he is sufficiently awake and stable before discharge.
