Tolerance to Propofol Generally Does Not Develop in Pediatric Patients Undergoing Radiation Therapy

Safe Anesthesia for Radiotherapy in Pediatric Oncology: St. Jude Children's Research Hospital Experience, 2004–2006

“…We also excluded sessions in which adjuncts to propofol were used, reasoning that this practice would tend to decrease the dosage of propofol given. Although one case report described tolerance to propofol after repeated anesthesia sessions (12), our study and other prospective evaluations have failed to identify tolerance to propofol, either clinically or through bispectral index monitoring of the level of consciousness during anaesthesia (13,14). We found a negative correlation between the total dose of propofol per session and the number of prior propofol-based anesthesia sessions.…”

“…Historically, a variety of anesthetic drugs and techniques have been used to facilitate pediatric radiation therapy, including inhalation anesthesia (1)(2)(3)(4); intramuscular and intravenous methohexital (5,6); oral, intramuscular, and intravenous ketamine (3,5,(7)(8)(9); intravenous thiopental (10); intravenous meperidine; intravenous midazolam; and oral chloral hydrate (11). In recent years, propofol has become the standard of anesthesia care for radiation therapy in children (3,6,(11)(12)(13)(14)(15)(16)(17). Its merits for use in pediatric external-beam radiation therapy include rapid and predictable induction of anesthesia, easily titratable depth of anesthesia, maintenance of spontaneous ventilation with minimal need for airway manipulation, and rapid recovery (3,6,(11)(12)(13)(14)(15)(16)(17).…”

“…In recent years, propofol has become the standard of anesthesia care for radiation therapy in children (3,6,(11)(12)(13)(14)(15)(16)(17). Its merits for use in pediatric external-beam radiation therapy include rapid and predictable induction of anesthesia, easily titratable depth of anesthesia, maintenance of spontaneous ventilation with minimal need for airway manipulation, and rapid recovery (3,6,(11)(12)(13)(14)(15)(16)(17). These characteristics are important in the context of repetitive daily anesthesia, as required for radiation therapy, and therefore propofol has become the drug of choice at our institution.…”

The influence of age and administration rate on the brain sensitivity to propofol in rats

“…A previous rat study could not detect tolerance to propofol following repeated administrations (17). Repeated propofol administration in children could not induce tolerance (18,19). However, in contrast to those results, tolerance has been demon-pofol.…”

Sedation and Anesthesia Options for Pediatric Patients in the Radiation Oncology Suite

“…Initial concerns about tachyphylaxis to propofol [25] have been disproved by more recent studies [26–28]. Thus propofol, combined with midazolam, provides excellent therapeutic conditions throughout the entire course of treatment [29]. Propofol has also been cited as being an excellent stand-alone drug to use in XRT without the need for benzodiazepine premedication.…”