Propofol sedation by emergency physicians for elective pediatric outpatient procedures

Guenther, Elisabeth; Pribble, Charles G.; Junkins, Edward P.; Kadish, Howard A.; Bassett, Kathlene E.; Nelson, Douglas S.

doi:10.1016/s0196-0644(03)00634-6

Cited by 109 publications

(62 citation statements)

References 35 publications

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“…34 Pediatric cardiology studies have shown that the use of ketamine reduces the dose of propofol required to achieve adequate sedation. 35 The median dose of propofol in this series of 0.8 mg ⁄ kg was low in comparison to studies using propofol alone for deep sedation.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Andolfatto

Willman

2010

Academic Emergency Medicine

103

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Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children.Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg ⁄ mL ketamine and 10 mg ⁄ mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded.Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg ⁄ kg each of ketamine and propofol (range = 0.2 to 3.0 mg ⁄ kg; IQR = 0.7 to 1.0 mg ⁄ kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale.Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied.

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Section: Discussionmentioning

confidence: 99%

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Andolfatto

Willman

2010

Academic Emergency Medicine

103

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“…Thus, adverse event rates for procedural sedation range from 0% to 20.1%. [20][21][22][23][25][26][27][29][30][34][35][36][37][38][39][40] One study demonstrated the safety and the efficacy of sedation in 405 children who underwent echocardiography. 31 Adverse events included oxygen desaturation (6%), vomiting (6%), and paradoxic agitation (1.9%).…”

Section: Adverse Events and Risk Factorsmentioning

confidence: 99%

Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Heistein

Ramaciotti²,

Scott³

et al. 2006

Pediatrics

100

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OBJECTIVE. The physiologic responses to chloral hydrate sedation in the setting of a pediatric echocardiography laboratory have not been well documented; neither has the population at risk been identified adequately. The purpose of this study was to describe the physiologic responses to chloral hydrate sedation, to report the occurrence of adverse events, and to identify any risk factors that predicted these adverse events in children who underwent sedation for echocardiography at our institution.METHODS. We analyzed retrospectively 1095 patients who were sedated for echocardiography. Vital signs and oxygen saturations were recorded every 5 minutes, and adverse events were noted. Potential risk factors for sedation-related adverse events were analyzed.RESULTS. Thirty-eight percent of patients were classified as American Society of Anesthesiologists class 3 or 4, reflecting the significant comorbidity in the study population. Hemodynamic responses to chloral hydrate sedation included Ն20% decreases in heart rate (24% of the patients) and blood pressure (59% of the patients). There were no deaths or permanent morbidity. Adverse events occurred in 10.8% of patients and included apnea (n ϭ 3 [0.3%]), airway obstruction (n ϭ 15 [1.4%]), hypoxia (n ϭ 65 [5.9%]), hypercarbia (n ϭ 40 of 603 [6.6%]), hypotension with poor perfusion (n ϭ 4 [0.4%]), vomiting (n ϭ 4 [0.4%]), and prolonged sedation (n ϭ 36 [3.3%]). No intervention was required in 92.5%, minor interventions were necessary in 7%, and major interventions were required in 0.5% of all patients. Multivariate analysis identified only age younger than 6 months as a predictor for adverse events, whereas cyanosis, hospitalization, American Society of Anesthesiologists class, fasting time, oxygen requirement, and use of additional sedation were not predictors.CONCLUSIONS. Moderate decreases in heart rate and blood pressure, in the absence of clinical deterioration, are expected responses to chloral hydrate sedation in this www.pediatrics.org/cgi

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“…3,6,7 The use of propofol, ketamine and etomidate have become commonplace in the ED as a result. 2,[8][9][10][11][12][13] The literature has supported this change for patients of all ages, [12][13][14] and even for those with significant pre-existing disease. 15,16 Evidence supports the use of such agents even in settings outside the ED or operating room by supervised nurses or by physicians without formal advanced airway or cardiac life support training.…”

Section: Introductionmentioning

confidence: 97%

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Campbell

Magee

Kovács

et al. 2006

CJEM

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Objectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital. Methods: Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period. Results: Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%-2.3%), and desaturation (SaO 2 ≤ 90) in 14 of 979 (1.4%; CI 0.1%-2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs. Conclusions: Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

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Propofol sedation by emergency physicians for elective pediatric outpatient procedures

Cited by 109 publications

References 35 publications

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Chloral Hydrate Sedation for Pediatric Echocardiography: Physiologic Responses, Adverse Events, and Risk Factors

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

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