Propofol Anesthesia for Invasive Procedures in Ambulatory and Hospitalized Children: Experience in the Pediatric Intensive Care Unit

Abstract

ABSTRACT. Objectives. To describe our experience with propofol anesthesia to facilitate invasive procedures for ambulatory and hospitalized children in the pediatric intensive care unit (PICU) setting.Methods. We retrospectively reviewed the hospital records of 115 children who underwent 251 invasive procedures with propofol anesthesia in our multidisciplinary, university-affiliated PICU during a 20-month period. All patients underwent a medical evaluation and were required to fast before anesthesia. Continuous monitoring of the patient's cardiorespiratory and neurologic status was performed by a pediatric intensivist, who also administered propofol in intermittent boluses to obtain the desired level of anesthesia, and by a PICU nurse, who provided written documentation. Data on patient demographics, procedures performed, doses of propofol used, the occurrence of side effects, induction time, recovery time, and length of stay in the PICU were obtained.Results. Propofol anesthesia was performed successfully in all children (mean age, 6.4 years; range, 10 days to 20.8 years) who had a variety of underlying medical conditions, including oncologic, infectious, neurologic, cardiac, and gastrointestinal disorders. Procedures performed included lumbar puncture with intrathecal chemotherapy administration, bone marrow aspiration and biopsy, central venous catheter placement, endoscopy, and transesophageal echocardiogram. The mean dose of propofol used for induction of anesthesia was 1.8 mg/kg, and the total mean dose of propofol used was 8.8 mg/kg. In 13% of cases, midazolam also was administered but did not affect the doses of propofol used. The mean anesthesia induction time was 3.9 minutes, and the mean recovery time from anesthesia was 28.8 minutes for all patients. The mean PICU stay for ambulatory and ward patients was 140 minutes. Hypotension occurred in 50% of cases, with a mean decrease in systolic blood pressure of 25%. The development of hypotension was not associated with propofol doses, the concomitant use of midazolam, or the duration of anesthesia, but was associated with older patient age. Hypotension was transient and not associated with altered perfusion. Intravenous fluid was administered in 61% of the cases in which hypotension was present. Respiratory depression requiring transient bag-valve-mask ventilation occurred in 6% of cases and was not associated with patient age, propofol doses, concomitant use of midazolam, or the duration of anesthesia. Transient myoclonus was observed in 3.6% of cases. Ninety-eight percent of procedures were completed successfully, and no procedure failures were considered secondary to the anesthesia. Patients, parents, and health care providers were satisfied with the results of propofol anesthesia.Conclusions. Propofol anesthesia can safely facilitate a variety of invasive procedures in ambulatory and hospitalized children when performed in the PICU and is associated with short induction and recovery times and PICU length of stay. Hypotension, although usually transien...

Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças

“…Our study is in line with the observation that propofol is well tolerated by children with preserved cardiac function and that blood pressure only decreases during induction, being more frequent in older children and adolescents. Our study has not recorded clinically significant heart rate decreases and cardiac rhythm changes with the association of sufentanil 10,19 . Fast recovery after prolonged propofol infusion, generally described 20 , was possible in patients receiving sufentanil.…”

“…Nosso estudo é coerente com a observação da qual o propofol é bem tolerado por crianças com função cardíaca preservada, e que a pressão arterial somente diminui durante a indução, fato que é mais freqüente em crianças maiores e adolescentes. Da mesma forma, no nosso estudo, não foram registradas reduções clinicamente importantes da freqüência cardíaca e alterações do ritmo cardíaco com a associação de sufentanil 10,19 .…”

Sedation in pediatric magnetic resonance imaging: a ten-year experience

“…Propofol is a newer hypnotic agent, more popular in anesthesia with its rapid action, short recovery time, and antiemetic effect [15]. But propofol may cause some respiratory complications depending on doses like hypoventilation, airway obstruction and apnea [16]. When a single agent is not sufficient for sedation in procedural anesthesia, various drug combinations may be a choice.…”

Pediatric Palliative Sedation Therapy with Propofol: Recommendations Based on Experience in Children with Terminal Cancer

“…However, these effects should be minimal when small doses are administered by highly trained staff, [20][21][22][23] and the recommended dose regimens are applied. All 3 cases reported here received propofol infusions in the intensive care unit and were cared for by pediatric intensivists and/or pediatric pain specialists with training in anesthesia.…”