Safety and efficacy of propofol administered by paediatricians during procedural sedation in children

Chiaretti, Antonio; Benini, Franca; Pierri, Filomena; Vecchiato, Katy; Ronfani, Luca; Agosto, Caterina; Ventura, Alessandro; Genovese, Orazio; Barbi, Egidio

doi:10.1111/apa.12472

Cited by 59 publications

(45 citation statements)

References 33 publications

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“…The other side of the story is illustrated by two exemplary reports covering approximately 50000 [19] or 25000 [20] patients in North America, both concluding that severe complications from propofol are quite rare. This was substantially confirmed by Chiaretti et al in the largest European study in more than 36,500 patients with propofol administration for PSA in children [21].…”

Section: Discussionsupporting

confidence: 62%

Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

2020

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Background: As more and more diagnostic and interventional options are becoming available for use in pediatric patients, techniques of procedural sedation analgesia (PSA) are being administered in considerably growing numbers as well. Aims: The objective of this research effort was to conduct the first countrywide survey on the status quo of sedation analgesia as delivered to children and adolescents in Germany. Methods:We dispatched letters to all pediatric hospital settings in Germany (n = 305), including a questionnaire that had been developed with existing guidelines taken into account. Its items were designed to elucidate the current practice of PSA throughout these pediatric centers regarding (a) organizational structures and (b) standards of medication and staffing. Results: A total of 138 centers returned the questionnaire, hence the response rate was 45.2%. Numerous centers had implemented adequate structures and staffing standards. Deficits were nevertheless identified, most notably in terms of on-location equipment and staff provided to deliver sedations. Essential items of equipment were not provided in up to 26.8% of centers. Adequate staffing was not provided in up to 44.2% of centers, depending on the diagnostic or interventional procedures for which the PSA was delivered. The most widely used sedative agents were midazolam, ketamine/esketamine, and propofol. Conclusions: Adequate care structures for the management of procedural sedation analgesia have been implemented by many pediatric centers in Germany. On the downside, these findings also reveal deficits that will take efforts to be eliminated.

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Section: Discussionsupporting

confidence: 62%

Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

2020

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“…However, the need for deeper sedation during procedures and anatomical differences contribute towards the development of complications. Higher rates of complications associated with sedation are encountered in children compared with adults 23. The most appropriate sedative drugs and experienced personnel are needed to reduce the risks associated with sedation in children.…”

Section: Discussionmentioning

confidence: 99%

A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial

Akbulut¹,

Saylan²,

Sengu³

et al. 2017

European Journal of Gastroenterology &Amp; Hepatology

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PurposeWe aimed to compare the efficacy and safety of midazolam plus ketamine versus fentanyl plus propofol combination administered to children undergoing upper gastrointestinal endoscopy (UGE) and to determine the most appropriate sedation protocol.Materials and methodsThis prospective, randomized, single-blind study included patients between the ages of 4 and 17 years who underwent UGE for diagnostic purposes. Patients were divided randomly into groups A (midazolam–ketamine combination, n=119) and B (fentanyl plus propofol combination, n=119). The effectiveness of the sedation and complications during the procedure and recovery period were recorded.ResultsThe processes started without an additional dose of the drug for 118 patients (99.1%) in group A and for 101 patients (84.8%) in group B (P=0.001). The average dose of ketamine administered to the patients in group A was 1.03±0.15 mg/kg and the average dose of propofol administered to the patients in group B was 1.46±0.55 mg/kg. None of the patients stopped the endoscopic procedure in group A, but one patient (0.8%) had to discontinue the endoscopic procedure in group B. 27 patients in group A (22.7%) and 41 patients (34.5%) in group B developed complications during the procedure (P=0.044). The rate of complications during the recovery of group A (110 patients, 92.4%) was significantly higher than that in group B (48 patients, 40.3%) (P=0.001).ConclusionIn children, UGE procedures can be quite comfortable when using the midazolam–ketamine combination. However, adverse effects related to ketamine were observed during recovery.

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“…Although sedation is usually safe, it is sometimes associated with serious adverse events (SAEs). The prevalence of SAEs is difficult to determine since their occurrence is infrequent, and due to the lack of large multicentered studies, which focus on the systemic findings of the adverse events [10]. A serious adverse event (SAE) may include apnea, hypotension, laryngospasm, bradycardia, clinically apparent pulmonary aspiration, complete airway obstruction, and permanent neurological damage or even death.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

Aslam¹,

Haque²,

Jamil³

et al. 2020

Cureus

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Safety and efficacy of propofol administered by paediatricians during procedural sedation in children

Abstract: This multicentre study demonstrates the safety and the efficacy of paediatrician-administered propofol for procedural sedation in children and highlights the importance of appropriate training for paediatricians to increase the safety of this procedure in children.

Cited by 59 publications

References 33 publications

Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany

A comparison of sedation with midazolam–ketamine versus propofol–fentanyl during endoscopy in children: a randomized trial

Safety and Efficacy of Procedural Sedation and Analgesia in Pediatric Oncology Patients

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