PEDIATRICS Vol. 106 No. 4 October 2000, pp. 742-747
Prospective Evaluation of Propofol Anesthesia in the Pediatric Intensive Care Unit for Elective Oncology Procedures in Ambulatory and Hospitalized Children
Received Sep 30, 1999; accepted Jan 18, 2000.
,,, and
From the Department of Pediatrics, Divisions of * Pediatric
Critical Care and Pulmonary Medicine and Pediatric
Hematology-Oncology, Georgetown University Medical Center, Washington,
DC.
Objectives. To evaluate our experience with propofol anesthesia delivered by pediatric intensivists in the pediatric intensive care unit (PICU) to facilitate elective oncology procedures in children performed by pediatric oncologists.
Methods. Elective oncology procedures performed with propofol anesthesia in our multidisciplinary, university-affiliated PICU were prospectively evaluated over a 7-month period. Ambulatory and hospitalized children were prescheduled for their procedure, underwent a medical evaluation, and met fasting requirements before the start of anesthesia. Continuous cardiorespiratory and neurologic monitoring was performed by a pediatric intensivist and a PICU nurse, while the procedure was performed by a pediatric oncologist. Propofol was delivered in intermittent boluses to achieve the desired level of anesthesia. Information studied included patient demographics, procedures performed, induction and total doses of propofol used, the duration of the different phases of the patient's PICU stay, the occurrence of side effects, the need for therapeutic interventions, and the incidence of recall of the procedure.
Results. Fifty procedures in 28 children (mean age: 7.5 ± 4.3 years) were evaluated. Sixty-one percent of patients had established diagnoses. Fifty-four percent of procedures were lumbar puncture with intrathecal chemotherapy administration and 26% of procedures were bone marrow aspirations with biopsy. Induction propofol doses were 2.0 ± .8 mg/kg for ambulatory and hospitalized patients, while total propofol doses were 6.6 ± 2.3 mg/kg and 7.9 ± 2.4 mg/kg for ambulatory and hospitalized patients, respectively. Induction time was 1.5 ± .7 minutes, recovery time was 23.4 ± 11.5 minutes, and total PICU time was 88.8 ± 27.7 minutes. Transient decreases in systolic blood pressure less than the fifth percentile for age occurred in 64% of procedures, with a mean decrease of 25% ± 10%. Intravenous fluids were administered in 31% of these cases. Hypotension was more common in ambulatory patients but was not predicted by propofol dose, anesthesia time, or age. Partial airway obstruction was noted in 12% of procedures while apnea requiring bag-valve-mask ventilation occurred in 2% of procedures. Neither was associated with age, propofol dose, or the duration of anesthesia. All procedures were successfully completed and there were no incidences of recall of the procedure.
Conclusions. Propofol anesthesia is effective in achieving patient comfort and amnesia, while optimizing conditions for elective oncology procedures in children. Although transient hypotension and respiratory depression may occur, propofol anesthesia seems to be safe to use for these procedures in the PICU setting. Recovery from anesthesia was rapid and total stay was brief. Under the proper conditions, propofol anesthesia delivered by pediatric intensivists in the PICU is a reasonable option available to facilitate invasive oncology procedures in children. Key words: propofol, anesthesia, pediatrics, pediatric oncology, procedures, pediatric intensive care.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Mantadakis, N. Katzilakis, E. Foundoulaki, and M. Kalmanti Moderate Intravenous Sedation With Fentanyl and Midazolam for Invasive Procedures in Children With Acute Lymphoblastic Leukemia Journal of Pediatric Oncology Nursing, July 1, 2009; 26(4): 217 - 222. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Vespasiano, M. Finkelstein, and S. Kurachek Propofol Sedation: Intensivists' Experience With 7304 Cases in a Children's Hospital Pediatrics, December 1, 2007; 120(6): e1411 - e1417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Pershad, J. Wan, and D. L. Anghelescu Comparison of Propofol With Pentobarbital/Midazolam/Fentanyl Sedation for Magnetic Resonance Imaging of the Brain in Children Pediatrics, September 1, 2007; 120(3): e629 - e636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Tofil, M. A. Buckmaster, M. K. Winkler, B. H. Callans, M. P. Islam, and A. K. Percy Deep Sedation With Propofol in Patients With Rett Syndrome J Child Neurol, October 1, 2006; 21(10): 857 - 860. [Abstract] [PDF]
|
|
|
|
|
|
N. M. Tofil, M. A. Buckmaster, M. K. Winkler, B. H. Callans, M. P. Islam, and A. K. Percy Deep Sedation With Propofol in Patients With Rett Syndrome J Child Neurol, March 1, 2006; 21(3): 210 - 214. [Abstract] [PDF]
|
|
|
|
|
|
K. S. Powers, E. B. Nazarian, S. A. Tapyrik, S. M. Kohli, H. Yin, E. W. van der Jagt, J. S. Sullivan, and J. S. Rubenstein Bispectral Index as a Guide for Titration of Propofol During Procedural Sedation Among Children Pediatrics, June 1, 2005; 115(6): 1666 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R. Glaisyer and M. R. J. Sury Recovery After Anesthesia for Short Pediatric Oncology Procedures: Propofol and Remifentanil Compared with Propofol, Nitrous Oxide, and Sevoflurane Anesth. Analg., April 1, 2005; 100(4): 959 - 963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Cravero and G. T. Blike Review of Pediatric Sedation Anesth. Analg., November 1, 2004; 99(5): 1355 - 1364. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Barbi, T. Gerarduzzi, F. Marchetti, E. Neri, E. Verucci, I. Bruno, S. Martelossi, G. Zanazzo, A. Sarti, and A. Ventura Deep Sedation With Propofol by Nonanesthesiologists: A Prospective Pediatric Experience Arch Pediatr Adolesc Med, November 1, 2003; 157(11): 1097 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Godambe, V. Elliot, D. Matheny, and J. Pershad Comparison of Propofol/Fentanyl Versus Ketamine/Midazolam for Brief Orthopedic Procedural Sedation in a Pediatric Emergency Department Pediatrics, July 1, 2003; 112(1): 116 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Shiley, K. Lalwani, and H. A. Milczuk Intravenous Sedation vs General Anesthesia for Pediatric Otolaryngology Procedures Arch Otolaryngol Head Neck Surg, June 1, 2003; 129(6): 637 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Crock, C Olsson, R Phillips, G Chalkiadis, S Sawyer, D Ashley, S Camilleri, J Carlin, and P Monagle General anaesthesia or conscious sedation for painful procedures in childhood cancer: the family's perspective Arch. Dis. Child., March 1, 2003; 88(3): 253 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. N. Cornfield, K. Tegtmeyer, M. D. Nelson, C. E. Milla, and M. Sweeney Continuous Propofol Infusion in 142 Critically Ill Children Pediatrics, December 1, 2002; 110(6): 1177 - 1181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Laham Propofol: Risk vs. Benefit Clinical Pediatrics, January 1, 2002; 41(1): 5 - 7. [PDF]
|
|
