Propofol, remifentanil, and low-dose atracurium besylate versus sevoflurane and fentanyl for bronchoscopy in children: a randomized-controlled trial

Objective The aim of this study was to compare the use of remifentanil and propofol infusion plus low-dose atracurium besylate technique with the commonly used inhalational technique using sevoflurane with fentanyl for children undergoing bronchoscopy for foreign body (FB) removal. Patients and methods This prospective randomized-controlled trial was conducted at Ain Shams University Hospitals. Sixty children aged 1–5 years planned for elective or emergency FB removal by bronchoscopy were included in the current study. The recruited children were assigned randomly into two groups: group I: total intravenous anesthesia (TIVA group) (remifentanil, propofol, and low-dose atracurium besylate); group II: volatile induction and maintenance of anesthesia (VIMA) (sevoflurane and fentanyl). Intraoperative and postoperative measurements and complications were recorded. Results There was no statistically significant difference between both groups in induction time, bronchoscopy time, time for discharge from the recovery room, and emergence time between both groups. The number of bronchoscopy attempts, interruptions of bronchoscopy, and body movements were significantly higher in the VIMA group than the TIVA group; satisfaction with surgery was greater in the TIVA group than the VIMA group. There was no difference between groups in the incidence of complications, except for postoperative agitation, with a higher incidence in the VIMA group compared with the TIVA group. Conclusion The use of 0.1 µg/kg/min remifentanil-propofol TIVA, plus a small dose (0.25 mg/kg) of atracurium besylate at induction, provided stable hemodynamics, better surgeon satisfaction, and less postoperative agitation compared with sevoflurane 2% in 100% oxygen plus fentanyl 1 µg/kg in children undergoing tracheobronchial FB removal during rigid bronchoscopy.