Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation

Paediatr Anaesth. 2004 Nov;14(11):941-6. doi: 10.1111/j.1460-9592.2004.01355.x.


Background: Flexible fiberoptic bronchoscopy is an important diagnostic tool for pediatric pulmonologists. Because of its favorable respiratory profile, ketamine has become a popular sedative for this procedure, but may be associated with unpleasant emergence reactions in the older child. Remifentanil is a newer, ultra-short acting opioid that has been shown to provide effective sedation and cough suppression for fiberoptic bronchoscopy when combined with intermittent propofol boluses. However, delivery of these agents as a combined, single infusion has not been described.

Methods: Children > or =2 years of age undergoing fiberoptic bronchoscopy were enrolled. Remifentanil was mixed in a single syringe with undiluted propofol giving final drug concentrations of 10 mg x ml(-1) of propofol and 15-20 microg x ml(-1) of remifentanil. Sedation was induced with a bolus of approximately 0.1 ml x kg(-1) of this mixture and maintained by titrating the drip throughout the procedure. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.

Results: Fifteen patients aged 9.0 +/- 5.3 years were sedated. Sedation was induced with 1.2 +/- 0.4 mg x kg(-1) propofol (2.4 +/- 0.8 microg x kg(-1) remifentanil) and maintained with 4.1 +/- 1.8 mg x kg(-1) x h(-1) propofol (0.13 +/- 0.06 microg x kg(-1) x min(-1) remifentanil). Five patients received low-dose ketamine to augment sedation. The maximal decrease in respiratory rate was 6.1 +/- 5.3 b x min(-1) (27.6 +/- 21%) and no patient became hypoxemic. All procedures were completed easily without significant complication. Patients recovered to baseline 13.3 +/- 8.5 min following infusion discontinuation.

Conclusions: A remifentanil/propofol mixture provided effective sedation and rapid recovery in pediatric patients undergoing fiberoptic bronchoscopy.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Anesthetics, Combined / adverse effects
  • Anesthetics, Combined / therapeutic use*
  • Anesthetics, Intravenous / adverse effects
  • Anesthetics, Intravenous / therapeutic use*
  • Blood Pressure / drug effects
  • Bronchoscopy / methods*
  • Child
  • Child, Preschool
  • Conscious Sedation / methods
  • Female
  • Fiber Optic Technology*
  • Heart Rate / drug effects
  • Humans
  • Male
  • Oxygen / blood
  • Piperidines / adverse effects
  • Piperidines / therapeutic use*
  • Propofol / adverse effects
  • Propofol / therapeutic use*
  • Prospective Studies
  • Remifentanil
  • Respiration / drug effects


  • Anesthetics, Combined
  • Anesthetics, Intravenous
  • Piperidines
  • Remifentanil
  • Oxygen
  • Propofol