Propofol sedation in children: sleep trumps amnesia

Abstract

Objective Detailed assessments of the effects of propofol on memory in children are lacking. We assessed the feasibility of measuring memory during propofol infusion, as commonly performed in sedation for MRI scanning. In addition, we determined the onset of memory loss in relation to the onset of sedation measured by verbal responsiveness. Materials and methods Children scheduled for sedation for MRI received a 10-min infusion of propofol (3 mg/kg) as they viewed and named 100 simple line drawings, one shown every five seconds, until they were no longer responsive (encoding). A control group receiving no sedation for MRI underwent similar tasks. Sedation was measured as any verbal response, regardless of correctness. After recovery from sedation, recognition memory was tested, with correct yes/no recognitions matched to sedation responses during encoding (subsequent memory paradigm). Results Of the 48 children who received propofol, 30 could complete all study tasks (6.2 ± 1.6 years, 16 males). Individual responses could be modeled in all 30 children. On average, there was a 50% probability of no verbal response 3.1 min after the start of infusion, with 50% memory loss at 2.7 min. Children receiving propofol recognized 65 ± 16% of the pictures seen, whereas the control group recognized 93 ± 5%. Conclusion Measurement of memory and sedation is possible in verbal children receiving propofol by infusion in a clinical setting. Despite propofol being an amnestic agent, there was little or no amnestic effect of propofol while the child was verbally responsive. It is important for sedation providers to realize that propofol sedation does not always produce amnesia while the child is responsive. ClinicalTrials.gov number NCT02278003.

Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial

“…Per definition, patient responsiveness is higher with minimal sedation, possibly a factor that lends itself to the suggestion that, at lower depths of sedation, the greater the attention and response to stimulus, the higher the subsequent risk of recall [36]. These findings support similar findings with dexmedetomidine and propofol, supporting that children who are verbally responsive to visual and verbal stimuli have a higher incidence of recall [11,12]. It should be noted, however, that increasing the level of sedation increases the risk of respiratory and airway adverse events [23].…”

“…Factors associated with amnesia include patient characteristics, level of sedation, and the method used to evaluate amnesia [10]. Establishing memory and recall in the pediatric population is challenging, with quantitative methods most frequently employed [9,11,12].…”

BMP7 attenuates propofol induced neuron apoptosis via modulating JNK and AKT signaling

“…Propofol has been world-widely used in general anesthesia for patients in all age groups due to its superior rapid-acting, amnesia and antiemetic effect [16][17]. Recently, its regulatory effect on the CNS has been drawn attentions, and studies from the last two decades remain controversial on whether propofol application exerts protective or harmful property on the neuron.…”

Comprehensive behavioral analysis of mice repeatedly treated with propofol

“…Propofol administration induced impairments in the performance of a memory task. In studies involving animal models and human patients, the amnestic effects of propofol were described [2,10,11,13]. These reports focused on the acute effect of propofol.…”

“…The exact mechanisms and effects of propofol on brain function are not well understood. In fact, the memory loss after anesthesia using propofol has been reported as a side effect [9][10][11]. In some animal models, memory impairment by propofol treatment was demonstrated [12,13].…”