Conscious Sedation of Children With Propofol Is Anything but Conscious

Reeves, Scott; Havidich, Jeana E.; Tobin, D Patrick

doi:10.1542/peds.114.1.e74

Cited by 61 publications

(25 citation statements)

References 15 publications

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“…Otherwise, forced pressure on children related to the procedure will cause pain and nervousness for the patients and the relatives, which are not good for the treatment. Furthermore, it is useless to console the children after the procedure (Reeves et al, 2004;Lundeberg and Roelofse, 2011;Masala et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

et al. 2015

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ABSTRACT. This study explored the sedative and analgesic effects of fentanyl combined with propofol via an intrathecal chemotherapy injection for acute leukemia (acute lymphocytic leukemia or acute myelocytic leukemia) among children, to relieve pain and difficulty during intrathecal injection, improve treatment compliance, increase the success rate of single puncture, and reduce procedure failure, with the aim of developing a painless procedure for children with acute leukemia. Fifty person-times received fentanyl combined with propofol via an intrathecal chemotherapy injection among the hospitalized children with leukemia. The patients' cooperation with the procedure, response to the medication, dosages of fentanyl and propofol, reaction to the procedures, wake-up time, and changes in oxygen saturation (SpO 2 ), heart rate (HR), respiration, and blood pressure (BP) before, during, and after the procedures were observed. The doctors who performed the procedures assessed the quality of sedation and analgesia. In the treatment group, the patients were quiet during the lumbar puncture and intrathecal injection, showing good sedation and analgesia. HR and respiration decreased slightly. There were no changes in SpO 2 and BP. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration, which stopped soon after the procedures. In the control group, the patients were agitated, crying, and not cooperative before and during the procedures, which made the procedures very difficult. During intrathecal injection, pain obviously reduced and the success rate of single lumbar puncture increased. It is safe and effective to apply fentanyl combined with propofol for sedation and analgesia.

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Section: Discussionmentioning

confidence: 99%

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

et al. 2015

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“…In accordance with previous studies, our data showed that propofol causes hypotension and might lead to hypoventilation or airway obstruction. [30][31][32][33][34] It should be therefore used only by experienced pediatric intensivists or anesthetists. The propofol infusion syndrome, a fatal combination of renal and cardiac failure, rhabdomyolysis, and acidosis, is related to a long-term propofol sedation of more than 48 hours, so patients should not be at risk when propofol is used for short-term procedural sedation.…”

Section: Discussionmentioning

confidence: 99%

Propofol Versus Midazolam/Ketamine for Procedural Sedation in Pediatric Oncology

Gottschling¹,

Meyer²,

Krenn³

et al. 2005

Journal of Pediatric Hematology/Oncology

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Different pharmacologic agents have been used for sedation in children undergoing invasive procedures. The authors prospectively compared the efficacy, the occurrence of adverse effects, cardiovascular parameters, oxygen saturation and induction, and recovery time in propofol with or without morphine versus midazolam/ketamine sedation for procedural sedation in children with malignancies and hematologic disorders. Fifty children received either propofol with or without morphine or ketamine/midazolam sedation for invasive procedures. Intravenous sedation consisted of 0.1 mg midazolam/kg and 1.0 mg ketamine/kg or 2 mg propofol/kg with or without 0.1 mg morphine/kg. Incremental dosages of ketamine or propofol were given, if necessary, to achieve or to maintain adequate sedation levels. Systolic and diastolic blood pressure, heart rate, oxygen saturation, time to induce sedation, recovery time, and adverse effects were recorded. All invasive procedures were successfully completed, with satisfactory sedation levels in all 25 patients in the propofol group and 23 of the 25 patients in the ketamine group. In 14 of the 25 procedures in the propofol group and 4 of the 25 procedures in the ketamine group, sedation was associated with side effects, the most common being oxygen desaturation. There was a significant increase in diastolic blood pressure after ketamine medication and a significant decrease in systolic and diastolic blood pressure and heart rate in the propofol group. Induction and recovery times in the propofol group were significantly shorter. Both regimens for procedural sedation are efficacious in achieving satisfactory sedation levels for invasive procedures. Propofol offers a quicker onset of sedation and a faster, smoother recovery but is associated with a higher rate of side effects. Considering the substantial rate of adverse effects, these procedural sedations should be performed only by physicians trained in advanced airway management and life support.

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“…431 Several sedation studies have examined the utility of this device and degree of correlation with standard sedation scales. 347,363,[432][433][434][435] It appears that there is some correlation with BIS values in moderate sedation, but there is not a reliable ability to distinguish between deep sedation and moderate sedation or deep sedation from general anesthesia. 432 Presently, it would appear that BIS monitoring might provide useful information only when used for sedation with propofol 363 ; in general, it is still considered a research tool and not recommended for routine use.…”

Section: Processed Eeg (Bispectral Index)mentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Coté¹,

Wilson²

2016

Pediatrics

254

199

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age-and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, suffi cient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the

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Conscious Sedation of Children With Propofol Is Anything but Conscious

Cited by 61 publications

References 15 publications

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

Propofol Versus Midazolam/Ketamine for Procedural Sedation in Pediatric Oncology

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

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