Safety and efficacy of sedation with propofol for transoesophageal echocardiography in children in an outpatient setting

Mart, Christopher R.; Parrish, Mitchell; Rosen, Kerry L.; Dettorre, Michael D.; Ceneviva, Gary D.; Lucking, Steven E.; Thomas, Neal J.

doi:10.1017/s1047951106000084

Cited by 20 publications

(9 citation statements)

References 20 publications

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“…Sedation and anesthesia for TEE in patients with CHD and children should be performed by experienced providers who understand the anatomy and pathophysiology of the specific lesions. 87 Esophageal intubation can be quite stimulating, therefore most children require deep sedation or general anesthesia, and an anesthesiologist or equivalent provider with expertise in caring for pediatric patients is usually involved in selecting, administering, and monitoring these agents. Close communication between the anesthesiologist and the echocardiographer prior to and during the procedure is essential.…”

Section: Sedation and Anesthesiamentioning

confidence: 99%

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic

Puchalski

Lui

Miller‐Hance

et al. 2019

Journal of the American Society of Echocardiography

123

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serves on the speakers bureau for Astra Zeneca.NOTICE AND DISCLAIMER: This report is made available by ASE as a courtesy reference source for members. This report contains recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in this report are primarily based on the opinions of experts, rather than on scientifically-verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the information in this report, including the warranty of merchantability or fitness for a particular purpose. In no event shall ASE be liable to you, your patients, or any other third parties for any decision made or action taken by you or such other parties in reliance on this information. Nor does your use of this information constitute the offering of medical advice by ASE or create any physician-patient relationship between ASE and your patients or anyone else.

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Section: Sedation and Anesthesiamentioning

confidence: 99%

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic

Puchalski

Lui

Miller‐Hance

et al. 2019

Journal of the American Society of Echocardiography

123

View full text Add to dashboard Cite

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“…[21][22][23] Propofol has been studied and shown to be safe and effective in pediatric patients undergoing a variety of procedures, like transesophageal echocardiography and MRI, in both inpatient and outpatient settings. [34][35][36] More important, combining propofol and ketamine has been evaluated in large case studies in patients with a variety of primary diagnoses, which include hematologic, oncologic, infectious, neurologic, and many other diagnoses. 21,37 This combination of agents has been studied in the emergency department, radiological imaging units and intensive care unit settings and has been found to be safe and effective when administered by skilled personnel, while also resulting in a more rapid recovery, shorter stay, and smoother anesthetic emergence.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections

Louer

McKinney

Abu‐Sultaneh

et al. 2019

PM&R

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Background: Pediatric patients with cerebral palsy often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Objective: To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT-A injections. Design: Retrospective chart review. Setting: The sedations took place in a procedural sedation suite at a tertiary children's hospital from February 2013 through September 2017. Patients: 164 patients with diagnoses of cerebral palsy undergoing propofol and ketamine based sedation for injections with botulinum toxin A. Methods: An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT-A injections. Main Outcome Measurements: Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed. Results: 345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (interquartile range [IQR]: 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time, and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events. Conclusion: Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT-A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients.

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“…The rate of severe complications is indicated as 0.18 %, while mortality accounts for less than 0.01 % [8,30]. Another analysis by Mart et al in pediatric patients with a deep propofol sedation for TEEs concludes that the rate of severe complications amounts to 4 %, including the necessity of mask ventilation and intubation [21]. Depending on the need for intervention, our complications are broken down into mild, medium or severe.…”

Section: Discussionmentioning

confidence: 99%

Presentation of a Sedation Standard Using the Example of Transesophageal Echocardiographies (TEE) in Pediatric Outpatients

et al. 2017

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Most pediatric patients require deep sedation for a TEE examination. We analyzed the data of our sedation protocols relating to all outpatient TEEs in patients under 18 years of age for the year 2011. On the basis of the data records of a total of 40 patients, we will describe our standard and compare it with the findings of the international literature. In a retrospective analysis, we inspected our sedation protocols in terms of patient-related data, vital parameters, drug applications, occurring complications and necessary interventions as well as nausea and vomiting during the post-sedative monitoring phase. In line with our standard, we applied atropine, midazolam, S-ketamine and propofol; complications occurred in 5 patients. They could be handled using simple measures. With regard to the vital parameters, no severe complications occurred. Dizziness was observed in 4 patients during the recovery phase; one patient complained about nausea and vomiting during the first fluid intake. All patients could be discharged 4 h after the termination of sedation. Our standard is a practicable and safe procedure for preforming TEE examinations in pediatric outpatients.

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Safety and efficacy of sedation with propofol for transoesophageal echocardiography in children in an outpatient setting

Cited by 20 publications

References 20 publications

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic

Guidelines for Performing a Comprehensive Transesophageal Echocardiographic

Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections

Presentation of a Sedation Standard Using the Example of Transesophageal Echocardiographies (TEE) in Pediatric Outpatients

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