Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy

Objective: To describe our experience with ketamine sedation during infant flexible fiberoptic bronchoscopy. Design: Retrospective chart review. Infants were sedated with midazolam and ketamine with or without fentanyl. The sedation regimen, final procedure performed, procedure duration, and complications were recorded. Complication rates between infants less than or equal to 6 months or > 6 months of age and between infants with upper vs lower airway symptoms were compared by chi(2) test with a contingency table. Results: Fifty-nine procedures were performed in 55 patients aged 6.1 +/- 3.1 months (mean +/- SD). Sedation was achieved with ketamine and midazolam (n = 30) or ketamine, midazolam, and fentanyl (n = 29). Bronchoscopy with BAIL was performed in 44 patients and bronchoscopy alone in 3 patients. In 11 patients, severe upper airway obstruction and/or anomalies prevented subglottic passage of the bronchoscope. One patient could not be adequately sedated. There were no major complications. Minor complications occurred in 14 patients (23.7%), most commonly mild hypoxemia. (n = 9). Brief central apnea developed in three patients. Complication rates were unaffected by age or indication for bronchoscopy. Conclusions: Infant flexible fiberoptic bronchoscopy can be safely and effectively performed using ketamine sedation. Complications, especially mild hypoxemia, appear more common in infants, likely due to smaller airway diameter. Regardless of the sedative(s) used, additional vigilance is required when performing bronchoscopy in this population.