Propofol kinetics are altered in very small babies and in children recovering from cardiac surgery. Increased peripheral distribution volume and reduced metabolic clearance following surgery causes prolonged elimination.

A combination of remifentanil and midazolam provided satisfactory sedation for these patients. Owing to enhanced clearance rates, smaller (younger) children will require higher remifentanil infusion rates than larger (older) children and adults to achieve equivalent blood concentrations.

SummaryPoly vinyl chloride (PVC) infusion equipment contains substantial amounts of the plasticiser di(2-ethylhexyl) phthalate (DEHP). We determined the amount of DEHP leached from Mediplus Dual TIVA Ò Infusion sets, into lipid and nonlipid infusates. Two propofol admixtures (Diprivan Ò 1%, Propoven Ò 1%), Intralipid Ò 10% and 0.9% saline were evaluated as infusates. Solutions were infused through TIVA sets at 12 ml.h )1 for 6 h at 24, 32 and 37°C. In addition, TIVA sets were filled with 2 ml infusates, sealed and incubated at 24 and 37°C for 6 h. Di(2-ethylhexyl) phthalate was detected in all lipid infusates after dynamic infusion and static contact, and in 0.9% saline after dynamic infusion at 37°C. At 32 and 37°C, the quantity of di(2-ethylhexyl) phthalate leaching into the lipid infusates may exceed the recommended maximum exposure amount set by the European Union for DEHP of 20-48 lg.kg Di(2-ethylhexyl) phthalate (DEHP) is a commonly used plasticiser in polyvinyl chloride (PVC) manufacture, imparting flexibility to a wide variety of applications. Di(2-ethylhexyl) phthalate is ubiquitous in the environment and it is estimated that approximately 70-100% of a given human population will have a detectable concentration of DEHP and ⁄ or its metabolites in their blood or urine at any time [1][2][3][4][5]. In animal studies, DEHP is a liver carcinogen and causes reproductive abnormalities in offspring exposed to the chemical during gestation and through to puberty; males are particularly affected [6][7][8][9]. However, the variability of effects between species means that, at present, the validity of extrapolating animal data to man remains unresolved. The use of DEHP as a plasticiser results from its non-covalent binding to PVC molecules, allowing the latter to slide over each other [10]. However, the noncovalent binding also results in DEHP's leaching from PVC into the surrounding environment [11]. Di(2-ethylhexyl) phthalate is a highly lipophilic molecule, so immersion in a lipid-containing environment will increase leaching [12].

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