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• W4243715931 abstract "Chest. 2004;125:315–21. Fauroux B, Onody P, Gall O, et al Comments: Many bronchoscopists prefer general anesthesia (GA) for performing flexible bronchoscopy in children. Although GA assures patient comfort, and better cough control during bronchoscopy, it is difficult to organize, increases cost of care, and places children at risks associated with anesthesia. Also, dynamic airway abnormalities, an important indication for pediatric bronchoscopy, cannot be evaluated in anesthetized children. As a result of these reasons, some centers prefer to perform bronchoscopy under conscious sedation and local anesthesia in pediatric patients. The aim of this study was to evaluate the efficacy of premixed 50% nitrous oxide and oxygen in improving the quality of sedation and pain control during FB in children. The study included a total of 105 children undergoing diagnostic or therapeutic FB. The patients were randomly assigned to receive either premixed 50% nitrous oxide and oxygen or premixed 50% nitrogen and oxygen. Both the endoscopy team and the patients were blinded to the mixture inhaled. All patients received intrarectal atropine and benzodiazepines. Lidocaine was used for topical anesthesia. The authors used several methods to assess the efficacy of the analgesic agent. The primary outcome measure was the rate of failure of the first inhalation mixture to control pain. The other outcome measures were 1) quality of sedation and pain control assessed using Children's Hospital of East Ontario pain Score (CHEOPS), 2) the patient's self reported assessment, 3) global pain control assessment by the endoscopy team, 4) self-reported pain by children >6 years using a visual analog scale, and 5) assessment of independent blinded observers who reviewed the videotape of the procedure. The failure rate was significantly lower in the nitrogen oxide group compared with the control group (21% vs. 62%, P < 0.05). Other outcome measures also showed a clear advantage of nitrogen oxide and oxygen inhalation during bronchoscopy than the nitrogen and oxygen inhalation. The onset of analgesic effect of inhaled nitrous oxide was rapid and its effect was short-lasting after stopping the treatment. Side effects were minor and were similar in both groups. The adequacy of patient comfort and pain control is an important consideration when bronchoscopy is performed in children. A sizable proportion of adult patient has reported poor pain control during flexible bronchoscopy despite sedation, analgesics, and topical anesthesia (Am J Respir Crit Care Med 2000;162:440–5 ). Similar data are not available in pediatric patients, but there is a general perception that suboptimal pain control during operative procedures is an important problem in pediatric patients. Nitrous oxide therapy has been used for its analgesic properties in various invasive procedures. The therapy has an established safety record in pediatric patients (Lancet 2001;358:1514–5 ), and it is easy to administer. This well-designed study establishes better sedation and pain control with premixed 50% nitrous oxide and oxygen in children undergoing FB. The results will encourage pediatric pulmonologists to incorporate this simple measure to better control pain associated with bronchoscopy in children." @default.
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• W4243715931 date "2004-04-01" @default.
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• W4243715931 title "The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients. A Randomized Double-Blind Controlled Study" @default.
• W4243715931 doi "https://doi.org/10.1097/00128594-200404000-00023" @default.
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