Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children

Objectives. To evaluate our experience with propofol anesthesia delivered b y pediatric intensivists in the pediatric intensive care unit (PICU) to fac ilitate elective oncology procedures in children performed by pediatric onc ologists. Methods. Elective oncology procedures performed with propofol anesthesia in our multidisciplinary, university- affiliated PICU were prospectively eval uated over a 7-month period. Ambulatory and hospitalized children were pres cheduled for their procedure, underwent a medical evaluation, and met fasti ng requirements before the start of anesthesia. Continuous cardiorespirator y and neurologic monitoring was performed by a pediatric intensivist and a PICU nurse, while the procedure was performed by a pediatric oncologist. Pr opofol was delivered in intermittent boluses to achieve the desired level o f anesthesia. Information studied included patient demographics, procedures performed, induction and total doses of propofol used, the duration of the different phases of the patient's PICU stay, the occurrence of side effect s, the need for therapeutic interventions, and the incidence of recall of t he procedure. Results. Fifty procedures in 28 children (mean age: 7.5 +/- 4.3 years) were evaluated. Sixty-one percent of patients had established diagnoses. Fifty- four percent of procedures were lumbar puncture with intrathecal chemothera py administration and 26% of procedures were bone marrow aspirations with b iopsy. Induction propofol doses were 2.0 +/- .8 mg/kg for ambulatory and ho spitalized patients, while total propofol doses were 6.6 +/- 2.3 mg/kg and 7.9 +/- 2.4 mg/kg for ambulatory and hospitalized patients, respectively. I nduction time was 1.5 +/- .7 minutes, recovery time was 23.4 +/- 11.5 minut es, and total PICU time was 88.8 +/- 27.7 minutes. Transient decreases in s ystolic blood pressure less than the fifth percentile for age occurred in 6 4% of procedures, with a mean decrease of 25% +/- 10%. Intravenous fluids w ere administered in 31% of these cases. Hypotension was more common in ambu latory patients but was not predicted by propofol dose, anesthesia time, or age. Partial airway obstruction was noted in 12% of procedures while apnea requiring bag-valve-mask ventilation occurred in 2% of procedures. Neither was associated with age, propofol dose, or the duration of anesthesia. All procedures were successfully completed and there were no incidences of rec all of the procedure. Conclusions. Propofol anesthesia is effective in achieving patient comfort and amnesia, while optimizing conditions for elective oncology procedures i n children. Although transient hypotension and respiratory depression may o ccur, propofol anesthesia seems to be safe to use for these procedures in t he PICU setting. Recovery from anesthesia was rapid and total stay was brie f. Under the proper conditions, propofol anesthesia delivered by pediatric intensivists in the PICU is a reasonable option available to facilitate inv asive oncology procedures in children.