Objectives: To describe our experience using propofol sedation to facilitate elective diagnostic and therapeutic procedures, and to document the safety profile of propofol in this setting.
Design: Retrospective consecutive case series and review of the literature.
Setting: Pediatric intensive care unit of a United States Navy tertiary care medical center.
Patients: Children receiving propofol for procedural sedation over an 18-month period.
Outcome Measures: Descriptive features of sedation including adverse events.
Results: During the study period, 91 children received propofol to facilitate the performance of 110 medical procedures. The mean induction dose was 2.41 mg/kg, the mean infusion rate was 179.3 μg/kg/min, and the mean total dose of propofol administered was 4.23 mg/kg. In all cases, sedation was successfully achieved. The average length of stay in the PICU was 108.4 minutes. Three children (3.3%) had transient episodes of oxygen desaturation that improved with repositioning of the airway. No child required placement of an endotracheal tube. Three (3.3%) children experienced hypotension requiring a decrease in the infusion rate of propofol and a 10-mL/kg bolus infusion of normal saline. No cardiac arrhythmias or adverse neurologic effects secondary to propofol infusion were identified.
Conclusions: Pediatric intensivists can safely and effectively administer propofol to facilitate the performance of diagnostic and therapeutic procedures outside the operating room setting.
Children admitted to the pediatric intensive care unit (PICU) frequently undergo potentially painful and anxiety-provoking procedures such as central line placement, arterial line placement, chest tube placement, and lumbar puncture. In addition, in recent years, there has been an emerging trend to perform elective diagnostic and therapeutic procedures in children, which formerly required hospitalization as same day ambulatory procedures. Studies have previously shown that children who undergo these procedures often find the actual procedure to be worse than their disease. 1,2 To facilitate the safe and successful performance of medical procedures in children, as well as to minimize complications and decrease the pain and anxiety associated with these procedures, many practitioners use either conscious or deep sedation. Many hospitals have created pediatric sedation centers designed especially for this purpose, while other hospitals use the PICU to perform outpatient medical procedures using conscious or deep sedation. 3,4 The choice of the best sedative agent to use during these procedures has yet to be determined, although the ideal agent would provide for a rapid onset of sedation and recovery, be easily titratable, and possess minimal side effects.
Propofol (2,6-diisopropylphenol, marketed in the United States as Diprivan®) is a relatively new intravenous anesthetic with a rapid onset of action and an easily titratable dose-dependent sedative effect that dissipates rapidly once its administration is discontinued. Propofol has been used extensively in the operating room setting and has demonstrated an excellent safety profile. 5-7 For these reasons, there is growing interest in the use of propofol to facilitate diagnostic and therapeutic medical procedures of short duration outside the operating room, either in a pediatric sedation center environment or the PICU. We retrospectively reviewed our experience with propofol sedation in children undergoing same day procedures in the PICU.