Propofol anesthesia for invasive procedures in ambulatory and hospitalizedchildren: Experience in the pediatric intensive care unit

Objectives. To describe our experience with propofol anesthesia to facilita te invasive procedures for ambulatory and hospitalized children in the pedi atric intensive care unit (PICU) setting. Methods. We retrospectively reviewed the hospital records of 115 children w ho underwent 251 invasive procedures with propofol anesthesia in our multid isciplinary, university-affiliated PICU during a 20-month period. All patie nts underwent a medical evaluation and were required to fast before anesthe sia. Continuous monitoring of the patients cardiorespiratory and neurologic status was performed by a pediatric intensivist, who also administered pro pofol in intermittent boluses to obtain the desired level of anesthesia, an d by a PICU nurse, who provided written documentation. Data on patient demo graphics, procedures performed, doses of propofol used, the occurrence of s ide effects, induction time, recovery time, and length of stay in the PICU were obtained. Results. Propofol anesthesia was performed successfully in all children (me an age, 6.4 years; range, 10 days to 20.8 years) who had a variety of under lying medical conditions, including oncologic, infectious, neurologic, card iac, and gastrointestinal disorders. Procedures performed included lumbar p uncture with intrathecal chemotherapy administration, bone marrow aspiratio n and biopsy, central venous catheter placement, endoscopy, and transesopha geal echocardiogram. The mean dose of propofol used for induction of anesth esia was 1.8 mg/kg, and the total mean dose of propofol used was 8.8 mg/kg. In 13% of cases, midazolam also was administered but did not affect the do ses of propofol used. The mean anesthesia induction time was 3.9 minutes, a nd the mean recovery time from anesthesia was 28.8 minutes for ail patients . The mean PICU stay for ambulatory and ward patients was 140 minutes. Hypo tension occurred in 50% of cases, with a mean decrease in systolic blood pr essure of 25%. The development of hypotension was not associated with propo fol doses, the concomitant use of midazolam, or the duration of anesthesia, but was associated with older patient age. Hypotension was transient and n ot associated with altered perfusion. Intravenous fluid was administered in 61% of the cases in which hypotension was present. Respiratory depression requiring transient bag-valve-mask ventilation occurred in 6% of cases and was not associated with patient age, propofol doses, concomitant use of mid azolam, or the duration of anesthesia. Transient myoclonus was observed in 3.6% of cases. Ninety-eight percent of procedures were completed successful ly, and no procedure failures were considered secondary to the anesthesia. Patients, parents, and health care providers were satisfied with the result s of propofol anesthesia. Conclusions. Propofol anesthesia can safely facilitate a variety of invasiv e procedures in ambulatory and hospitalized children when performed in the PICU and is associated with short induction and recovery times and PICU len gth of stay. Hypotension, although usually transient, is common, and respir atory depression necessitating assisted ventilation may occur. Therefore, a ppropriate monitoring and cardiorespiratory support capabilities are essent ial. Propofol anesthesia in the PICU setting is a reasonable therapeutic op tion available to pediatric intensivists to help facilitate invasive proced ures in ambulatory and hospitalized children.