Induction Dosage of Propofol for Repeated Sedations in Children With Hematological Disorders

Abstract

Pediatric patients with hematologic malignancies require several procedural sedations by means of propofol infusion. We retrospectively analyzed the medical records of leukemic pediatric patients who had undergone procedural sedations at an Italian tertiary referral center (San Gerardo Hospital, Monza) from January 2011 to November 2013. We retrieved the following: demographics; diagnosis; chemotherapy phase; use of corticosteroids; induction dosage of propofol, fentanyl and/or ketamine; and the type of procedure. We used a multivariate linear mixed model to evaluate the factors affecting induction propofol dose. We analyzed 1459 procedures (59% lumbar punctures, 31% bone marrow aspirations) performed on 96 children (7 [4-10] y old, 24 [16-34] kg, 37% female) admitted for acute lymphoblastic leukemia (80%), lymphoma (11%), and acute myeloid leukemia (7%). The induction propofol dose increased by 0.03 mg/kg per each procedure (P<0.05), from 2.6 (2.0-3.2) to 3.5 (2.6-4.3) mg/kg at the first and the last procedure, respectively. Higher age, weight, and use of ketamine were associated to lower propofol dosage (P<0.01), while combined procedures increased propofol dosage (P<0.01). In a large cohort of leukemic pediatric patients undergoing procedural sedation, the induction dose of propofol was increased over time, regardless of weight, age, use of corticosteroids, diagnosis, and treatment phase.

Effect of Repeated Exposure to Sevoflurane on Electroencephalographic Alpha Oscillation in Pediatric Patients Undergoing Radiation Therapy: A Prospective Observational Study

“…In a cohort of pediatric patients with hematologic malignancies, a previous study found that the induction dose of propofol had to be increased over time. 6 An obvious difference between that study and ours is that it evaluated propofol dose as the endpoint to evaluate tolerance, instead of evaluating a change in effect as we did in our study. In addition, the propofol dose was determined by the anesthesiologist in the previous study and this A B C FIGURE 1.…”

“…Animal models show the development of acute tolerance to the hypnotic effect of propofol 2 but in pediatric patients, the findings have been mixed. [3][4][5][6] Gamma-aminobutyric acid (GABA) A receptor-dependent general anesthetic acts in the central nervous system (CNS) and leads to dose-dependent stereotypical changes in neural oscillations 7,8 that can be recorded noninvasively with an electroencephalogram (EEG). Analysis of the EEG in the frequency domain (ie, spectral analysis) is an increasingly popular method to understand the mechanism and effect of anesthetics on the brain.…”

“…There is controversial evidence suggesting the development of tolerance to propofol. Animal models show the development of acute tolerance to the hypnotic effect of propofol 2 but in pediatric patients, the findings have been mixed 3–6 …”