Abstract
INTRODUCTION: Anesthesia often facilitates invasive procedures in children, but operating room resources may not always be available. Propofol is available for use in many PICUs, and its rapid onset and brief duration of action makes it an ideal agent for short procedures. We reviewed our experience with propofol anesthesia in children undergoing elective procedures in a PICU setting. METHODS: Patient's hospital records were retrospectively reviewed. ASA guidelines for fasting were followed. Continuous EKG, respiratory rate, pulse oximetry and intermittent noninvasive Mood pressure measurements were performed. A pédiatrie intensivist monitored the patient and administered propofol in intermittent boluses to maintain adequate anesthesia A nurse monitored the patient and recorded data. Patients were eligible for discharge when fully awake and drinking. RESULTS: During a 19 month period, 208 procedures with propofol were performed in 101 patients. 176 cases were brought to the PICU solely for the procedure. Patient age was 77.3 ±63.7 months. Procedures performed included LP with intratbecal chemotherapy (83), bone marrow aspiration (57), and central venous line placement (41). 98% of procedures were successful, no failures were related to anesthesia. Propofol induction dose was 1.8 ±1.1 mg/kg, total dose was 8.96.2 mg/kg. Induction time was 3.9 i 3.0 min, recovery time 28.0 ±18.2 min, and PICU length of stay 139.3 ±87.3 min. 50% of cases developed systolic BP < 5th percentile for age. 31% of cases received crystalloid infusions (9.8 ±8.1 ml/kg) for hypotension. Hypotension was brief and not associated with adverse sequelae. Transient bag-mask ventilation was administered in 7% of cases. Airway obstruction resulted in intubation in 1 % of cases. Myoclonns was observed in 3% of cases. The development of hypotension or myoclonus or the need for bag-mask ventilation was not associated with the induction or the total dose of propofol (p > 0.05). All patients recovered to their baseline status. CONCLUSIONS: Propofol facilitates a variety of invasive procedures in children and is associated with short induction and recovery times and PICU length of stay. Hypotension, although usually transient, is common. Propofol anesthesia may be safely administered to children during elective procedures in the PICU setting when proper cardiorcspiralory monitoring and support modalities are employed.