Propofol for Sedation and Control of Intracranial Pressure in Children

Spitzfaden, Andrew C.; Jimenez, David F.; Tobias, Joseph D.

doi:10.1159/000028861

Cited by 36 publications

(9 citation statements)

References 21 publications

(23 reference statements)

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“…Intracranial pressure (ICP) monitoring plays a valuable role in the management of children with head injuries as well as atraumatic conditions associated with intracranial hypertension [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. Overall, insertion of an ICP monitor is felt to be a safe and effective adjunct in the management of raised ICP, with a low incidence of hemorrhagic or infectious complications [15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27].…”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Bláha

Lazar²,

Winn³

et al. 2003

Pediatr Neurosurg

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Intracranial pressure (ICP) monitoring plays a valuable role in the management of head injuries and other causes of raised ICP in the pediatric population. The purpose of this study was to investigate the incidence of hemorrhage after ICP monitor insertion, and to classify these complications in a clinically relevant manner. Hospital charts of 431 children (ages 0–16 years) admitted to a level I trauma center over a 2-year period were reviewed and 112 patients (134 insertions) who underwent intraparenchymal ICP monitoring were identified. The authors reviewed postoperative neuroradiological studies. One hundred and nineteen procedures were carried out without any hemorrhage (grade 0). After 10 insertions, a small punctate hemorrhage or localized subarachnoid hemorrhage occurred (grade 1). Three patients sustained an intracerebral hemorrhage that did not require evacuation or manifest as a new neurological deficit (grade 2). There were no hemorrhagic complications that necessitated evacuation or resulted in a noticeable change in the patient’s clinical condition (grade 3). We propose a new grading system for hemorrhage after ICP monitor insertion. We found a complication rate close to 10% in our pediatric patients. Fortunately, these hemorrhages were clinically silent and no neurosurgical intervention was necessary. However, grade 1 and grade 2 hemorrhages may manifest with a false reading of high ICP, and the long-term consequences of these complications are not known. Of note, only 23% of these complications were reflected in the patients charts, which may explain the low complication rates reported in other studies that did not analyze postoperative neuroradiological studies.

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Section: Introductionmentioning

confidence: 99%

Hemorrhagic Complications of Intracranial Pressure Monitors in Children

Bláha

Lazar²,

Winn³

et al. 2003

Pediatr Neurosurg

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“…Propofol also has anticonvulsant properties and reduces ICP which can be advantageous in sedating a patient with epilepsy or a patient with concerns for obstructive hydrocephalus due to a malfunctioning ventriculoperitoneal shunt to obtain diagnostic neuroradiologic imaging [44–46]. While there have been cases of propofol providing adequate sedation and successfully treating intracranial hypertension [47, 48], several pediatric traumatic brain injury case reports have reported metabolic acidosis and death in patients on prolonged (24 hrs) continuous infusion of propofol [49–53]. In the 2003 published guidelines for the care of severe pediatric traumatic brain-injured patients, “continuous infusion of propofol is not recommended” [54].…”

Section: Resultsmentioning

confidence: 99%

Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders

Kilbaugh

Friess

Raghupathi

et al. 2010

International Journal of Pediatrics

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Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy). The overall objectives of this paper are (1) to provide an overview on recent studies that highlight the increased risk for respiratory complications following sedation and analgesia in children with developmental disabilities and neurologic disorders, (2) to provide a better understanding of sedatives and analgesic medications which are commonly used in children with developmental disabilities and neurologic disorders on the central nervous system.

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“…Given these concerns, propofol is not endorsed by the guidelines for the use of sedation in the treatment of severe pediatric traumatic brain injury [12]. Based on our previous clinical experience, we occasionally use short-term propofol infusions (less than 48 h) as an adjunct to the medical management of increased ICP [13]. However, we routinely follow acid-base status, urine for myoglobin, and creatinine phosphokinase values every 4-8 h and discontinue the propofol at any potential indication of the development of the propofol infusion syndrome [13].…”

Section: Discussionmentioning

confidence: 99%